Woodmere Squad 1 - Daily

• Document No.

• Conducted on

  Date

• Level and shift

  Select ALS BLS 7a - 7p 7p - 7a

  • ALS
  • BLS
  • 7a - 7p
  • 7p - 7a

• On duty

  Select CPT McCary LT Buffington LT Ali FF/Medic Decaprio FF/Medic Bialek FF/Medic Swanson FF/Medic Green FF/Medic Swiney FF/Medic Kowalski FF/Medic Strauss FF/EMT Aaron Cammon FF/EMT Adrian Cammon FF/EMT Sanchez FF/EMT Brynak FF/EMT Zilman FF/EMT Lavender FF/EMT Perrin FF/EMT Nafasi FF/EMT West FF/EMT Johnson FF/EMT Clark FF/EMT Jackson FF/EMT Large FF/EMT Mosley FF/EMT Doran FF/EMT Walton FF/EMT Arth

  • CPT McCary
  • LT Buffington
  • LT Ali
  • FF/Medic Decaprio
  • FF/Medic Bialek
  • FF/Medic Swanson
  • FF/Medic Green
  • FF/Medic Swiney
  • FF/Medic Kowalski
  • FF/Medic Strauss
  • FF/EMT Aaron Cammon
  • FF/EMT Adrian Cammon
  • FF/EMT Sanchez
  • FF/EMT Brynak
  • FF/EMT Zilman
  • FF/EMT Lavender
  • FF/EMT Perrin
  • FF/EMT Nafasi
  • FF/EMT West
  • FF/EMT Johnson
  • FF/EMT Clark
  • FF/EMT Jackson
  • FF/EMT Large
  • FF/EMT Mosley
  • FF/EMT Doran
  • FF/EMT Walton
  • FF/EMT Arth

• Name:

• Enter photos as needed

  Media

Front cab & exterior lighting

• Miles (enter miles)

• Fuel. >3/4

  Yes

  No

  N/A

• All emergency reds working?

  Yes

  No

  N/A

• All flood lights working?

  Yes

  No

  N/A

• Headlights - high & low beams working?

  Yes

  No

  N/A

• All turn signals working?

  Yes

  No

  N/A

• Rear view camera working?

  Yes

  No

  N/A

• Siren working?

  Yes

  No

  N/A

• Horn working?

  Yes

  No

  N/A

• Air horn working?

  Yes

  No

  N/A

• I pad present and fully charged

  Yes

  No

  N/A

• Binoculars

  Yes

  No

  N/A

• HAZMAT guide 2016

  Yes

  No

  N/A

• Garage door opener

  Yes

  No

  N/A

Driver side long

• O2. (Enter psi)

• Stair chair

  Yes

  No

  N/A

• O2 wrench x1

  Yes

  No

  N/A

Drivers side rear

• LUCAS x1

  Yes

  No

  N/A

Passenger side rear (can be accessed from inside)

• Backboards x3 w straps

  Yes

  No

  N/A

• Reeves x1

  Yes

  No

  N/A

• KED boards x1

  Yes

  No

  N/A

• Pediatric boards x1

  Yes

  No

  N/A

• C collar -adult x3

  Yes

  No

  N/A

• C collar -Peds x3

  Yes

  No

  N/A

• Head beds x3

  Yes

  No

  N/A

• Splint boards

  Yes

  No

  N/A

• Fire tape X1 roll

  Yes

  No

  N/A

• MCI bag x1

  Yes

  No

  N/A

• Sager splint x1

  Yes

  No

  N/A

Airway cabinet (left)

• AA batteries

  Yes

  No

  N/A

• 9 volt batteries

  Yes

  No

  N/A

• Ring cutter x1

  Yes

  No

  N/A

• Tongue Depressers

  Yes

  No

  N/A

• O2 wall adapter x1

  Yes

  No

  N/A

• O2 wrench

  Yes

  No

  N/A

• Pulse ox - Peds x2

  Yes

  No

  N/A

• Fluid shields

  Yes

  No

  N/A

• BVM adult x1

  Yes

  No

  N/A

• BVM Peds x1

  Yes

  No

  N/A

• BVM Neonate x1

  Yes

  No

  N/A

• Nebulizer Peds x1

  Yes

  No

  N/A

• CPAP mask - small

  Yes

  No

  N/A

• CPAP mask - medium

  Yes

  No

  N/A

• CPAP mask - large

  Yes

  No

  N/A

• N95 masks

  Yes

  No

  N/A

• Hand held suction refill x1

  Yes

  No

  N/A

• Aerosol mask - Peds x1

  Yes

  No

  N/A

• Oxykid mask - Peds x1

  Yes

  No

  N/A

• Merconium Aspirator x1

  Yes

  No

  N/A

• Stylet 14fr x1

  Yes

  No

  N/A

• Stylet 10fr x1

  Yes

  No

  N/A

• Suction catheter kits w/chimney valve x3

  Yes

  No

  N/A

• Suction tubing x2

  Yes

  No

  N/A

• Yankauer x1

  Yes

  No

  N/A

• ET tube holders x3

  Yes

  No

  N/A

• ET tube tape x2

  Yes

  No

  N/A

• Nasal airways x4

  Yes

  No

  N/A

• King airway video scope x1

  Yes

  No

  N/A

Airway cabinet (right)

• EZ - IO needles

  Yes

  No

  N/A

• EKG electrodes x2 packs

  Yes

  No

  N/A

• Defib pads - adult x2

  Yes

  No

  N/A

• Defib pads - Peds x2

  Yes

  No

  N/A

• Cable test adapter x1

  Yes

  No

  N/A

• Canister wipes x1

  Yes

  No

  N/A

Airway cabinet (lower)

• Portable razors x4

  Yes

  No

  N/A

• Lancets

  Yes

  No

  N/A

• LUCAS battery x1

  Yes

  No

  N/A

• LUCAS charger x1

  Yes

  No

  N/A

• LIFEPAK batteries x2 (charged)

  Yes

  No

  N/A

• Pens

  Yes

  No

  N/A

• Razor blades

  Yes

  No

  N/A

• Alcohol wipes

  Yes

  No

  N/A

• EKG paper x2 rolls

  Yes

  No

  N/A

• Keys

  Yes

  No

  N/A

• NS aerosol

  Yes

  No

  N/A

• Razor & Charger x1

  Yes

  No

  N/A

Locked cabinet & drug box

• Drug box #

• Drug box seal #

• IV NS 1000 ml x3

  Yes

  No

  N/A

• IV NS 500ml x3

  Yes

  No

  N/A

• D10 250 ml x1

  Yes

  No

  N/A

• Pressure infuser x1

  Yes

  No

  N/A

• MARKS kit x1

  Yes

  No

  N/A

Cabinet under locked cabinet (can be accessed from outside)

• O2 secured x3

  Yes

  No

  N/A

• CPAP kit x1

  Yes

  No

  N/A

• Pediatric bag (red) x1

  Yes

  No

  N/A

• Trauma bag (green) x1

  Yes

  No

  N/A

• Burn kit (yellow) x1

  Yes

  No

  N/A

• Vacuum splint S,M,L & pump

  Yes

  No

  N/A

Cot, monitor & patient area lighting

• Clipboard w/pens

  Yes

  No

  N/A

• O2 (enter psi)

• LIFEPAK 15. User & transmission test completed & successful

  Yes

  No

  N/A

• Batteries x2 fully charged

  Yes

  No

  N/A

• Defib pads - adult x2

  Yes

  No

  N/A

• Pulse ox

  Yes

  No

  N/A

• Capnography - nasal x1

  Yes

  No

  N/A

• Capnography - oral x1

  Yes

  No

  N/A

• EKG leads X1 pack

  Yes

  No

  N/A

• Pulse ox - Peds x1

  Yes

  No

  N/A

• Razors x2

  Yes

  No

  N/A

• BP cuffs S,M,L X1 each

  Yes

  No

  N/A

• 3 lead cables (LL LA RL RA)

  Yes

  No

  N/A

• 12 lead cables (v1 v2 v3 v4 v5 v6)

  Yes

  No

  N/A

• Electrical suction working?

  Yes

  No

  N/A

• All lighting in patient area working?

  Yes

  No

  N/A

• Cell phone

  Yes

  No

  N/A

• Cell phone charger

  Yes

  No

  N/A

Cabinet above short bench seat

• Red biohazard bags

  Yes

  No

  N/A

• Soft restraints

  Yes

  No

  N/A

• Extra BP cuffs

  Yes

  No

  N/A

• Disposable vomit bags

  Yes

  No

  N/A

Small bench seat underneath

• Gloves - multiple sizes

  Yes

  No

  N/A

Trauma cabinet (left side)

• IV drip set 10 gtts x5

  Yes

  No

  N/A

• IV drip set 60 gtts x5

  Yes

  No

  N/A

• NS flush x5

  Yes

  No

  N/A

• IV start kits x5

  Yes

  No

  N/A

• Saline locks x5

  Yes

  No

  N/A

• Tegaderms

  Yes

  No

  N/A

• IV touniquets

  Yes

  No

  N/A

• Syringes - various sizes

  Yes

  No

  N/A

Trauma cabinet (right side)

• 2x2 x10

  Yes

  No

  N/A

• 4x4. X5

  Yes

  No

  N/A

• Abdominal pads x3

  Yes

  No

  N/A

• Advance clotting sponge x3

  Yes

  No

  N/A

• Petroleum gauze

  Yes

  No

  N/A

• Trauma dressing x4

  Yes

  No

  N/A

• Quick trach x1

  Yes

  No

  N/A

• Cold pack x4

  Yes

  No

  N/A

• Hot pack x4

  Yes

  No

  N/A

• Sterile foil

  Yes

  No

  N/A

• MAT tourniquet x2

  Yes

  No

  N/A

• SAM splint x1

  Yes

  No

  N/A

• Gauze bandage wrap x4

  Yes

  No

  N/A

• Black twist tourniquets x2

  Yes

  No

  N/A

• Triangle bandage x1

  Yes

  No

  N/A

• Goggles x1

  Yes

  No

  N/A

• Misc band aids

  Yes

  No

  N/A

Long bench seat underneath

• Blankets x4

  Yes

  No

  N/A

• OB kit x2

  Yes

  No

  N/A

• Infection control kit x1

  Yes

  No

  N/A

• Basin x1

  Yes

  No

  N/A

• Canister wipes x1

  Yes

  No

  N/A

Cabinets over long bench seat

• NRB x3

  Yes

  No

  N/A

• N/C x3

  Yes

  No

  N/A

• Nebulizer x3

  Yes

  No

  N/A

• Towels & linen

  Yes

  No

  N/A

• RES Q POD x2

  Yes

  No

  N/A

IV boat

• IV start kits x2

  Yes

  No

  N/A

• Trauma shears x1

  Yes

  No

  N/A

• Prep wipes

  Yes

  No

  N/A

• NS flushes x2

  Yes

  No

  N/A

• Saline locks x2

  Yes

  No

  N/A

• Carpujet x3

  Yes

  No

  N/A

• 2x2

  Yes

  No

  N/A

• Tape x2

  Yes

  No

  N/A

• IV tourniquets

  Yes

  No

  N/A

• Tegaderms

  Yes

  No

  N/A

• Needles 16g x2

  Yes

  No

  N/A

• Needles 18g x2

  Yes

  No

  N/A

• Needles 20g x2

  Yes

  No

  N/A

• Needles 22g x2

  Yes

  No

  N/A

• Needles 24 g x2

  Yes

  No

  N/A

Jump bag (blue)

Left

• Stethoscope & Manual BP cuff

  Yes

  No

  N/A

• BP cuff, Peds X1 & BP cuff adult X1<br>

  Yes

  No

  N/A

Front

• Pulse ox x1

  Yes

  No

  N/A

• Glucometer kit x1

  Yes

  No

  N/A

• Meter x1

  Yes

  No

  N/A

• Test strips

  Yes

  No

  N/A

• Lancets

  Yes

  No

  N/A

• Prep pads

  Yes

  No

  N/A

Top

• Manual suction x1

  Yes

  No

  N/A

• King airway size 3 x1

  Yes

  No

  N/A

• King airway size 4 x1

  Yes

  No

  N/A

• King airway size 5 x1

  Yes

  No

  N/A

• King Vision Video scope screen x1

  Yes

  No

  N/A

• Intubation kit

  Yes

  No

  N/A

• Note any deficiencies below

• Signature 1 certifies that all items have been checked and deficiencies noted and also includes follow up items for deficiencies where applicable for Risk Management purposes

  Sign

• Signature 2 certifies that all items have been checked and deficiencies noted and also includes follow up items for deficiencies where applicable for Risk Management purposes

  Sign

• Signature 3 certifies that all items have been checked and deficiencies noted and also includes follow up items for deficiencies where applicable for Risk Management purposes

  Sign