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Station # |
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Mileage: |
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OB Kit (2) |
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Truck number: |
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Mounted fire extinguisher (1) |
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Fuel level |
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Stocked IV Tray (1) |
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Engine oil |
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Folding stretcher/stair chair |
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Coolant level |
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Normal saline/LR (5 ea.) |
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Brake fluid |
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10/60/Medsystem III drop sets (5 ea.) |
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Power steering fluid |
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Latex free kit (1) |
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Transmission fluid |
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EMT Shears (2) |
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Lights (Head, Tail, Signal, Marker, Hazards) |
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Suction catheters (2 ea. 6-16 Fr.) |
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Lights (Emergency) |
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Yankauer suction device (3) |
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Siren/Horn |
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Replacement suction containers (3) |
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Cleanliness of truck |
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On-board suction works properly |
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Heat/AC Front/back |
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Combitube (2) |
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Wipers/washers |
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NRB-Adult (5) |
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Tire tread |
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NC- Adult (5) |
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Body damage |
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Oropharyngeal airway kit (1) |
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Exterior glass |
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Nasopharyngeal airway kit (1) |
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Leaks under truck |
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Nebulizers (5) |
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Compartment doors |
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NRB-Pedi (3) |
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Back-up alarm/lights |
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NC-Pedi (3) |
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VHF radio-front |
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Sterile 4x4 (25) |
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VHF radio-rear |
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Sterile 8x10 (10) |
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UHF radio |
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Gauze wrap- assoted sizes (10) |
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Onboard O2 PSI (>500) |
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Occlusive dressings (5) |
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Backboards (2) with 3 straps each |
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Burn pack (1) |
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C-collars(4-adult, 2-pedi) |
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Hot/Cold Packs (5 ea.) |
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Head immobilizers (2) |
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Irrigation solution (5) Earliest exp.: |
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Vest style immobilizer (1) |
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Sheets/Blankets/Pillow with cases |
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Pedi-immobilizer (1) |
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Bed pan/Urinal (1) |
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Cardiac monitor -Style: |
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Emesis basins (5) |
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Defibrillator test (attach report) |
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Extremity splints |
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Electrodes/Pads (Adult and Pediatric)(2 ea) |
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Alcohol preps (25) |
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Wheeled cot (1) |
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Latex gloves (1 box ea. S-XL) |
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IV Pump- Style: |
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Stocked Pedi Bag* |
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C-PAP with (3) circuits |
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Stocked Jump Bag* |
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Automatic BP Cuff |
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Stocked Airway bag* |
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Portable O2 (2) PSI (>500) |
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Crich kit (1) |
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BVM-Adult (1-Cabinet, 1-Jump bag) |
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Laptop and notebook (1) |
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BVM-Pedi (1) |
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Reflective vests |
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BVM-Infant (1) |
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Drug log signed? |
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Portable suction unit with tubing (1) |
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Drug count accurate? |
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BP Cuff (1 ea. Infant-Large adult) |
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Stethescope (1 ea. Adult and pedi) |
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First in kit (D-stick, O2 sat, Therm., BP, Penlight) |
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Pediatric jump kit with Broselow tape (1) |
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Traction splint (1Adult and pedi) |
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Remarks:
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Crewmember 1 Signature: |
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Crewmember 2 Signature: |
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