WMAS Pre-Shift Inspection Checklist V1.2

Vehicle Callsign

• Odometer

• If Other/Off Station Callsign

• HUB

  Select WARWICK COVENTRY WORCESTER HEREFORD HOLLYMOOR SANDWELL DUDLEY BROMSGROVE ERDINGTON LICHFIELD SHREWSBURY DONNINGTON WILLENHALL STAFFORD TOLLGATE TRAINING SCHOOL

  • WARWICK
  • COVENTRY
  • WORCESTER
  • HEREFORD
  • HOLLYMOOR
  • SANDWELL
  • DUDLEY
  • BROMSGROVE
  • ERDINGTON
  • LICHFIELD
  • SHREWSBURY
  • DONNINGTON
  • WILLENHALL
  • STAFFORD
  • TOLLGATE
  • TRAINING SCHOOL

• Conducted on

  Date

• Prepared by

• Shift

  Select 0600-1800 0630-1630 0630-1830 0700-1900 0730-1930 0800-2000 1000-2200 1100-2300 1200-0000 1500-0300 1630-0230 1800-0600 1830-0630 1900-0700

  • 0600-1800
  • 0630-1630
  • 0630-1830
  • 0700-1900
  • 0730-1930
  • 0800-2000
  • 1000-2200
  • 1100-2300
  • 1200-0000
  • 1500-0300
  • 1630-0230
  • 1800-0600
  • 1830-0630
  • 1900-0700

• Day of Week

  Select Monday Tuesday Wednesday Thursday Friday Saturday Sunday

  • Monday
  • Tuesday
  • Wednesday
  • Thursday
  • Friday
  • Saturday
  • Sunday

• CD's Booked Out

  Yes

  No

• Crewmate

• Student

  Yes

  No

• Name

• University

  Coventry University

  Wolverhampton University

  Birmingham City University

  Worcester University

  Staffordshire University

• Present for Shift

  Yes

  No

Safety

• WINDSCREEN: Damage Free

  Compliant

  Non-Compliant

• OIL: Check Engine Oil Level

  Compliant

  Non-Compliant

• DEF: Check AdBlue Level

  Compliant

  Non-Compliant

• LIGHTS: Check tailights / indicators / headlight / interior

  Compliant

  Non-Compliant

• Faulty Item

  Select Head-light N/S Head-light O/S High Beam N/S High Bean O/S Fog Light Front N/S Fog Light Front O/S Fog Light Rear N/S Fog Light Rear O/S Indicator Front O/S Indicator Front N/S Indicator Mirror O/S Indicator Mirror N/S Indicator Rear O/S Indicator Rear N/S High Level Indicator O/S High Level Indicator N/S Brake Light O/S Brake Light N/S High Level Brake O/S High Level Brake N/S Reverse N/S Reverse O/S

  • Head-light N/S
  • Head-light O/S
  • High Beam N/S
  • High Bean O/S
  • Fog Light Front N/S
  • Fog Light Front O/S
  • Fog Light Rear N/S
  • Fog Light Rear O/S
  • Indicator Front O/S
  • Indicator Front N/S
  • Indicator Mirror O/S
  • Indicator Mirror N/S
  • Indicator Rear O/S
  • Indicator Rear N/S
  • High Level Indicator O/S
  • High Level Indicator N/S
  • Brake Light O/S
  • Brake Light N/S
  • High Level Brake O/S
  • High Level Brake N/S
  • Reverse N/S
  • Reverse O/S

• SEATBELTS: Check all in good condition

  Compliant

  Non-Compliant

• Location of Fault

  Driver

  Passenger

  Saloon - Attendant

  Saloon - Rearmost Passenger

  Saloon - Forward Passenger

• BLUE LIGHTS: Check functionality

  Compliant

  Non-Compliant

• Faulty Item

  Select High Level Light Bar - Front High Level Light Bar - Rear Grill Repeater Junction Repeater - Number Plate Junction Repeater - Wing N/S Junction Repeater - Wing O/S Dual Function Cab - N/S Dual Function Cab - O/S High Mount Flank - O/S Front High Mount Flank - O/S Rear High Mount Flank - N/S Front High Mount Flank N/S Rear Rear Pillar Repeater - N/S Rear Pillar Repeater - O/S

  • High Level Light Bar - Front
  • High Level Light Bar - Rear
  • Grill Repeater
  • Junction Repeater - Number Plate
  • Junction Repeater - Wing N/S
  • Junction Repeater - Wing O/S
  • Dual Function Cab - N/S
  • Dual Function Cab - O/S
  • High Mount Flank - O/S Front
  • High Mount Flank - O/S Rear
  • High Mount Flank - N/S Front
  • High Mount Flank N/S Rear
  • Rear Pillar Repeater - N/S
  • Rear Pillar Repeater - O/S

• FIRE EXTINGUISHER: Must be in vehicle

  Compliant

  Non-Compliant

• MIRRORS: Damage Free

  Compliant

  Non-Compliant

• Side

  Near Side

  Off Side

Equipment

• Made Ready by Crew?

  Yes

  No

• Duty AFA

  Select I.Poyner J.Downes C.Daly S.Vickers P.Wotton External

  • I.Poyner
  • J.Downes
  • C.Daly
  • S.Vickers
  • P.Wotton
  • External

• Cause

• TYRES: Check Condition

  Compliant

  Non-Compliant

• TYRES: Tread Depth Nominal

  Compliant

  Non-Compliant

• TYRES: Lug nut witness tabs present and Correctly aligned

  Safe

  At Risk

• Location of Fault

  N/S Front

  N/S Rear

  O/S Front

  O/S Rear

• BLS/ALS BAGS: Present and Tagged

  Compliant

  Non-Compliant

• Non-Compliant

  Select ALS Bag BLS Bag

  • ALS Bag
  • BLS Bag

• Untagged

  Select IO Pouch Airways Pouch Rx Pouch Fluids Pouch Arrest Checklist

  • IO Pouch
  • Airways Pouch
  • Rx Pouch
  • Fluids Pouch
  • Arrest Checklist

• Missing

  Select IO Drill Needle Large Needle Small Three Way Tap Flushes

  • IO Drill
  • Needle Large
  • Needle Small
  • Three Way Tap
  • Flushes

• Missing

  Select IGel Size 5 IGel Size 4 IGel Size 3 IGel Size 2.5 IGel Size 2 IGel Size 1.5 IGel Size 1 Thomas Tube Holder Filter ETCo2 T-Piece Lubricant Tracheostomy Mask Needle Cric Kit Catheter Mount ET Tube Size 6

  • IGel Size 5
  • IGel Size 4
  • IGel Size 3
  • IGel Size 2.5
  • IGel Size 2
  • IGel Size 1.5
  • IGel Size 1
  • Thomas Tube Holder
  • Filter
  • ETCo2
  • T-Piece
  • Lubricant
  • Tracheostomy Mask
  • Needle Cric Kit
  • Catheter Mount
  • ET Tube Size 6

• Missing

  Select Adrenaline 1:10,000 Amiodarone

  • Adrenaline 1:10,000
  • Amiodarone

• Missing

  Select Atropine Glucose NaCl 500ml Giving Set Three Way Tap 50ml Syringe

  • Atropine
  • Glucose
  • NaCl 500ml
  • Giving Set
  • Three Way Tap
  • 50ml Syringe

• Missing

  Select Main Compartment Centre Netting Cannulation Pouch Rx Pouch First Aid Pouch Manual Suction PPe Pouch Tuff Cuts Airway Mask Pouch Obs Pouch

  • Main Compartment
  • Centre Netting
  • Cannulation Pouch
  • Rx Pouch
  • First Aid Pouch
  • Manual Suction
  • PPe Pouch
  • Tuff Cuts
  • Airway Mask Pouch
  • Obs Pouch

• Missing

  Select Oxygen Adult BVM Paediatric BVM

  • Oxygen
  • Adult BVM
  • Paediatric BVM

• Missing

  Select OPA 000 OPA 00 OPA 0 OPA 1 OPA 2 OPA 3 OPA 4 Laryngescope Handle Mac 4 Miller 1 Macgills Large Macgills Small NPA 6 NPA 7 NPA 8 Lubrication

  • OPA 000
  • OPA 00
  • OPA 0
  • OPA 1
  • OPA 2
  • OPA 3
  • OPA 4
  • Laryngescope Handle
  • Mac 4
  • Miller 1
  • Macgills Large
  • Macgills Small
  • NPA 6
  • NPA 7
  • NPA 8
  • Lubrication

• Missing

  Select Cannula Pack Disposable Tourniquet Flush Water for Injection Steret Luer Lock Cap Syringe 10ml Syringe 5ml Syringe 3ml Syringe 1ml Three Way Tap MAD Chloroprep Needle Orange Needle Green Needle Yellow Drawing up Needle Filter Straw Cannula 22g Cannula 20g Cannula 18g Cannula 16g Cannula 14g

  • Cannula Pack
  • Disposable Tourniquet
  • Flush
  • Water for Injection
  • Steret
  • Luer Lock Cap
  • Syringe 10ml
  • Syringe 5ml
  • Syringe 3ml
  • Syringe 1ml
  • Three Way Tap
  • MAD
  • Chloroprep
  • Needle Orange
  • Needle Green
  • Needle Yellow
  • Drawing up Needle
  • Filter Straw
  • Cannula 22g
  • Cannula 20g
  • Cannula 18g
  • Cannula 16g
  • Cannula 14g

• Missing

  Select Glucagon Purple Syringe Ampoule Breaks Salbutamol 5mg Salbutamol 2.5mg Atrovent 500mcg Atrovent 250mcg Glucose Gel Paracetamol PO Ibuprofen PO Aspirin PO Calpol Sachet Nurofen Sachet GTN Co-Amoxiclav Hydrocortisone Benzylpenicillin Paracetamol IV Three Way Tap Giving Set TXA Furosemide Ondansetron Adrenaline 1:1000 Chlorphenamine Atropine Naloxone

  • Glucagon
  • Purple Syringe
  • Ampoule Breaks
  • Salbutamol 5mg
  • Salbutamol 2.5mg
  • Atrovent 500mcg
  • Atrovent 250mcg
  • Glucose Gel
  • Paracetamol PO
  • Ibuprofen PO
  • Aspirin PO
  • Calpol Sachet
  • Nurofen Sachet
  • GTN
  • Co-Amoxiclav
  • Hydrocortisone
  • Benzylpenicillin
  • Paracetamol IV
  • Three Way Tap
  • Giving Set
  • TXA
  • Furosemide
  • Ondansetron
  • Adrenaline 1:1000
  • Chlorphenamine
  • Atropine
  • Naloxone

• Missing

  Select Clinical Waste Bag Clinical waste label Clinical waste tie Large Dressing Small Dressing Triangular Bandage Gauze Irripod Tape Rhino Pinch Small Bandage Medium Bandage Large Bandage

  • Clinical Waste Bag
  • Clinical waste label
  • Clinical waste tie
  • Large Dressing
  • Small Dressing
  • Triangular Bandage
  • Gauze
  • Irripod
  • Tape
  • Rhino Pinch
  • Small Bandage
  • Medium Bandage
  • Large Bandage

• Missing

  Select Goggles Masks Sleeve Protectors Aprons Clinical Waste Bag

  • Goggles
  • Masks
  • Sleeve Protectors
  • Aprons
  • Clinical Waste Bag

• Missing

  Select Adult NRB Paediatric NRB Adult Venturi Paediatric Venturi Acorn Venturi 40% T-Piece

  • Adult NRB
  • Paediatric NRB
  • Adult Venturi
  • Paediatric Venturi
  • Acorn
  • Venturi 40%
  • T-Piece

• Missing

  Select Tympanic Thermometer Axilla Thermometer Tympanic Covers BGL Machine BGL Strips Keytone Strips Sterets Lancets Gauze Discharge Sheets Head Wound/Injury Advice Sheets Safer Sleep Leaflet Pentorch

  • Tympanic Thermometer
  • Axilla Thermometer
  • Tympanic Covers
  • BGL Machine
  • BGL Strips
  • Keytone Strips
  • Sterets
  • Lancets
  • Gauze
  • Discharge Sheets
  • Head Wound/Injury Advice Sheets
  • Safer Sleep Leaflet
  • Pentorch

• MONITOR: Functional and Charged

  Compliant

  Non-Compliant

• MONITOR: Operational Test Complete

  Yes

  No

• STRETCHER: Present and Undamaged

  Compliant

  Non-Compliant

• VENTILATOR: Present

  Yes

  No

• SUCTION: Present and Functioning

  Yes

  No

• Missing?

  Yes

  No

• Non-Functioning

  Yes

  No

• CABINETRY: Stock present and Cabinets Tagged

  Compliant

  Non-Compliant

• Untagged Cabinet(s)

  Select ALS Bag Airway Small Airway Large IP&C Major Trauma Bag C Collars HeadBlocks Triage Pouch IP&C Bag VX/Sarin Neurotoxin Attack Pouch Fluids Cupboard Pick & Mix 1st Aid Pick & Mix Cannulation Vacuum Splints Moving and Handling Spare POM’s Pouch Level III PPe Pouches Carry Sheet Maternity Bag Clingfilm Miscarriage Pouch Pre-term Heat Pad

  • ALS Bag
  • Airway Small
  • Airway Large
  • IP&C
  • Major Trauma Bag
  • C Collars
  • HeadBlocks
  • Triage Pouch
  • IP&C Bag
  • VX/Sarin Neurotoxin Attack Pouch
  • Fluids Cupboard
  • Pick & Mix 1st Aid
  • Pick & Mix Cannulation
  • Vacuum Splints
  • Moving and Handling
  • Spare POM’s Pouch
  • Level III PPe Pouches
  • Carry Sheet
  • Maternity Bag
  • Clingfilm
  • Miscarriage Pouch
  • Pre-term Heat Pad

• Missing

  Select Adult NRB Paediatric NRB Adult Venturi Paediatric Venturi Acorn Venturi 40% T-Piece Rhino Pinch Entonox Mouthpiece Entonox Masks Face Masks PPe Level II Tracheostomy Kit

  • Adult NRB
  • Paediatric NRB
  • Adult Venturi
  • Paediatric Venturi
  • Acorn
  • Venturi 40%
  • T-Piece
  • Rhino Pinch
  • Entonox Mouthpiece
  • Entonox Masks
  • Face Masks PPe Level II
  • Tracheostomy Kit

• Missing

  Select Size 00 Size 0 Size 1 Size 2 Size 3 Size 4 Size 5

  • Size 00
  • Size 0
  • Size 1
  • Size 2
  • Size 3
  • Size 4
  • Size 5

• Missing

  Select Adult BVM Paediatric BVM Suction Spares Adult Magills Paediatric Maglls Foil Blankets iGels Lubrication Sachet’s NPA’s Laryngescope Spares Thomas Tube Holder Catheter Mount Needle Cric Kit Ventilator Tubing

  • Adult BVM
  • Paediatric BVM
  • Suction Spares
  • Adult Magills
  • Paediatric Maglls
  • Foil Blankets
  • iGels
  • Lubrication Sachet’s
  • NPA’s
  • Laryngescope Spares
  • Thomas Tube Holder
  • Catheter Mount
  • Needle Cric Kit
  • Ventilator Tubing

• Missing

  Select Catheter Size 12g Catheter Size 14g Catheter Size 16g Catheter Size 18g Yankuer Maxi Yankuer Midi Vax Sax/Suction Liner Suction Tubing

  • Catheter Size 12g
  • Catheter Size 14g
  • Catheter Size 16g
  • Catheter Size 18g
  • Yankuer Maxi
  • Yankuer Midi
  • Vax Sax/Suction Liner
  • Suction Tubing

• Missing

  Select Size 6 Size 7 Size 8

  • Size 6
  • Size 7
  • Size 8

• Missing

  Select Size 5 Size 4 Size 3 Size 2.5 Size 2 Size 1.5 Size 1

  • Size 5
  • Size 4
  • Size 3
  • Size 2.5
  • Size 2
  • Size 1.5
  • Size 1

• Missing

  Select Laryngescope Handle Miller 1 Mac 4

  • Laryngescope Handle
  • Miller 1
  • Mac 4

• Missing

  Select Urine Bags Vomit Bowls Clinell Green Clinell Blue Tissues Spill Pack Sharps Bin Clinical Waste Bag Clinical Waste Ties Clinical Waste Lables Domestic Waste Bag Laundry Bags Alginate Bags Pt own Rx Bags Pt Property Bags Paper towel roll Air Freshner Inco Sheets Sanitizer Tottles Consumables

  • Urine Bags
  • Vomit Bowls
  • Clinell Green
  • Clinell Blue
  • Tissues
  • Spill Pack
  • Sharps Bin
  • Clinical Waste Bag
  • Clinical Waste Ties
  • Clinical Waste Lables
  • Domestic Waste Bag
  • Laundry Bags
  • Alginate Bags
  • Pt own Rx Bags
  • Pt Property Bags
  • Paper towel roll
  • Air Freshner
  • Inco Sheets
  • Sanitizer Tottles
  • Consumables

• Missing

  Select Adult Defib Pads Paediatric Defib Pads ECG Paper ECG Electrodes Tympanic Covers ETCo2 Line Filter

  • Adult Defib Pads
  • Paediatric Defib Pads
  • ECG Paper
  • ECG Electrodes
  • Tympanic Covers
  • ETCo2 Line
  • Filter

• Missing

  Select Modular Bandage Blast Bandage Trauma Tourniquet Chest Seal Nightingale Dressing Haemostatic Gauze Pelvic Binder TST Pouch

  • Modular Bandage
  • Blast Bandage
  • Trauma Tourniquet
  • Chest Seal
  • Nightingale Dressing
  • Haemostatic Gauze
  • Pelvic Binder
  • TST Pouch

• Missing

  Select Adult Paediatric

  • Adult
  • Paediatric

• Missing

  Select Tyvek Suit L Tyvek Suit XL Tyvek Suit XXL Heavy Duty Gloves Boot Covers Safety Glasses Sleeve Protectors Disposable Aprons Face Visors

  • Tyvek Suit L
  • Tyvek Suit XL
  • Tyvek Suit XXL
  • Heavy Duty Gloves
  • Boot Covers
  • Safety Glasses
  • Sleeve Protectors
  • Disposable Aprons
  • Face Visors

• Missing

  Select IV Paracetamol IV NaCl 250ml IV NaCl 500ml Glucose Bag Activated Charcoal Bottle Water Water for Injections Giving Set Three Way Tap 50ml Syringe

  • IV Paracetamol
  • IV NaCl 250ml
  • IV NaCl 500ml
  • Glucose Bag
  • Activated Charcoal
  • Bottle Water
  • Water for Injections
  • Giving Set
  • Three Way Tap
  • 50ml Syringe

• Missing

  Select Large Medium Small Handpump

  • Large
  • Medium
  • Small
  • Handpump

• Missing

  Select Slide Sheets Handling Belt S Handling Belt M Handling Belt L Banana Board Turntable

  • Slide Sheets
  • Handling Belt S
  • Handling Belt M
  • Handling Belt L
  • Banana Board
  • Turntable

• Missing

  Select Gauze Tuff Cuts Disposable Razors Ampoule Breakers Irripods BGL Lancets Tech Tape Small Bandage Medium Bandage Large Bandage Triangular Bandage 10x10 Dressing 20x20 Dressing OPA’s

  • Gauze
  • Tuff Cuts
  • Disposable Razors
  • Ampoule Breakers
  • Irripods
  • BGL Lancets
  • Tech Tape
  • Small Bandage
  • Medium Bandage
  • Large Bandage
  • Triangular Bandage
  • 10x10 Dressing
  • 20x20 Dressing
  • OPA’s

• Missing

  Select Size 000 Size 00 Size 0 Size 1 Size 2 Size 3 Size 4

  • Size 000
  • Size 00
  • Size 0
  • Size 1
  • Size 2
  • Size 3
  • Size 4

• Missing

  Select Syringes Flushes Water for Injections 50ml Syringe Consumables Cannulas

  • Syringes
  • Flushes
  • Water for Injections
  • 50ml Syringe
  • Consumables
  • Cannulas

• Missing

  Select 20ml 10ml 5ml 3ml 1ml Luer Lock Caps Purple Syringe

  • 20ml
  • 10ml
  • 5ml
  • 3ml
  • 1ml
  • Luer Lock Caps
  • Purple Syringe

• Missing

  Select Cannula Pack Chloroprep Needle 21g Needle 23g Needle SubCut Disposable Tourniquet Alcohol Steret Nasal Atomiser Filter Straw Drawing up Needle Tech Tape

  • Cannula Pack
  • Chloroprep
  • Needle 21g
  • Needle 23g
  • Needle SubCut
  • Disposable Tourniquet
  • Alcohol Steret
  • Nasal Atomiser
  • Filter Straw
  • Drawing up Needle
  • Tech Tape

• Missing

  Select 22g 20g 18g 16g 14g

  • 22g
  • 20g
  • 18g
  • 16g
  • 14g

• Missing

  Select Adrenaline 1:10,000 Adrenaline 1:1000 Amiodarone Co-Amoxiclav Salbutamol 2.5mg Salbutamol 5mg Atrovent 250mcg Atrovent 500mcg Calpol Sachet Paracetamol PO Ibuprofen PO Aspirin PO Benzylpenicillin Water for Injections GTN Glucose Gel Glucagon Hydrocortisone Tranexamic Acid Ondansetron Furosemide Chlorphenamine Naloxone Atropine Nurofen

  • Adrenaline 1:10,000
  • Adrenaline 1:1000
  • Amiodarone
  • Co-Amoxiclav
  • Salbutamol 2.5mg
  • Salbutamol 5mg
  • Atrovent 250mcg
  • Atrovent 500mcg
  • Calpol Sachet
  • Paracetamol PO
  • Ibuprofen PO
  • Aspirin PO
  • Benzylpenicillin
  • Water for Injections
  • GTN
  • Glucose Gel
  • Glucagon
  • Hydrocortisone
  • Tranexamic Acid
  • Ondansetron
  • Furosemide
  • Chlorphenamine
  • Naloxone
  • Atropine
  • Nurofen

• OXYGEN: Vehicle O2 present, alarm test and full

  Compliant

  Non-Compliant

• Missing

  Select Large O2 Tank Small O2 Spare Spare Entonox Main Entonox

  • Large O2 Tank
  • Small O2 Spare
  • Spare Entonox
  • Main Entonox

• MANGAR PUMP: Battery functional and charged

  Compliant

  Non-Compliant

External Bodywork

• Check external bodywork for any new scratches, dints etc.

  Safe

  At Risk

Cleaning

• CABIN

  Good

  Fair

  Poor

• SALOON

  Good

  Fair

  Poor

• EXTERIOR

  Good

  Fair

  Poor

Fuel

• Must be a minimum of 3/4 full. (Do not wait until end of day)

  Compliant

  Non-Compliant

Completion

• Signature

  Sign

Defect Form

• Defect Form Completed?

  Yes

  N/A

• Log Number

• Date & Time Reported

  Date

• Picture

  Media

Any other actions taken

• Detail actions here