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Emergency Vehicle Inspection and Equipment Checklist
Section 1: Daily Fluid Check
1. Checked?
Yes
No
N/A
2. Oil
Yes
No
3. Antifreeze
Yes
No
4. Transmission Fluid
Yes
No
5. Break Fluid
Yes
No
6. Windshield Fluid
Yes
No
7. Steering Fluid
Yes
No
Section 2: Tire Pressures
1. Checked?
Yes
No
N/A
2. Drivers Side Front
Yes
No
3. PSI
4. Passenger Front
Yes
No
5. PSI
6. Drivers Rear Tire
Yes
No
7. PSI
8. Drivers Inner Tire
Yes
No
9. PSI
10. Passenger Rear Tire
Yes
No
11. PSI
12. Passenger Inner Tire
Yes
No
13. PSI
14. Treads OK?
Yes
No
N/A
Section 3: Compartment A-1 6 Emesis Basins 1 Current OSHA Book 1 Jane Biohazard Book 6 Bottles NSS 1 ANSI Vest 2 PPE Kits 1 NIOSH Book 1 Box Particle Masks 6 Bottles Sterile Water
1. Tag #'s
2. add media
Media files attached
Section 4: Compartment A-2 4 Adult NRB 4 Adult Nasal Cannula 4 Nebulizers 1 Pocket Mask 2 Adult BVM 1 Spare Suction Canister w/tubing 1 Each French 6,8,10,12,14,16,18 Catheters 6 Oral Airways 2 Adult Simple 2 Adult Trach Masks 2 Oxygen Tubing 1 Humidifier Kit 4 Yankauer 6 Surgilube 5 Nasal Airways
1. Tag #'s
2. add media
Media files attached
Section 5: Shelf A-3 2 - Blankets 2 - Sheets
1. Linen Stocked?
Yes
No
N/A
2. add media
Media files attached
Section 6: Compartment A-4 Pedi Bag Trauma Bag 1 CPAP Unit 1 CPAP Spare Circuit
1. Pedi Bag Tag #
2. Trauma Bag Tag #'s
3. C-PAP Tag #
4. C-PAP Spare Circuit
Yes
No
N/A
Section 7: Compartment A-5 6 -Pillow Cases 6 - Sheets 6 - Towels 6 - Blankets
1. Tag #'s
Section 8: Compartment A-6 5 Hot Packs 10 Triangle Bandages 3 Burn Sheets 10 Combine Dressings 1 Box 4x4's 1 Roll Hypo Tape 1 Box Tissues 5 Brown Paper Bags 4 Small Kling 1 Bulb Syringe 10 Non Adhering Dressings 2 OB Kits 3 Oral Glucose 1 Crash Shears 1 Foil Baby Bunting 5 Cold Packs 1 SAM Splint 5 Trauma Dressings 1 Box 2x2's 4 Rolls of Various Tape 10 Drinking Cups 1 Thermometer w Covers 1 Box Band Aids 4 Large Kling 1 Ring Cutter 1 Razor 1 Roll Sterile Aluminum Foil 1 Pen Light 1 Bandage Scissors
1. Tag #'s
Section 9: Interior Shelf Area
1. Main Oxygen PSI
2. Suction Working
Yes
No
N/A
3. Suction Canister w/tubing
Yes
No
N/A
4. 1 - Yankauer
Yes
No
N/A
5. ALS Protocol Book
Yes
No
N/A
6. 10 HIPAA Forms
Yes
No
N/A
Section 10: Compartment A-7
1. 1 - Box Non-Latex Gloves
Yes
No
N/A
2. 1 Box Large Non-Latex Gloves
Yes
No
N/A
Section 11: Compartment A-8
1. Tag #
2. Spare ANSI Vest
Yes
No
N/A
Section 12: Compartment A 9 2 - Boxes Small Non-Latex Gloves 1 - IV Kit 3 - Each IV Caths 14,16,18,20,22,24 5 - OP Sites 1 - Bottle Baby ASA 3 - Flushes 2 - IV Start Kits 1 - 500 NSS 1 - 20 Drip 1 - Roll Tape 1 - Nitro Spray 2 - Extension Sets 5 - Alcohol Wipes
1. 2 Boxes Small Non-Latex Gloves
Yes
No
N/A
2. 1 IV Kit
Yes
No
N/A
3. 1 Bottle Baby ASA
Yes
No
N/A
4. Baby ASA Expiration Date
5. 1 Bottle Nitro Spray
Yes
No
N/A
6. Nitro Spray Expiration
Section 13: Compartment A-10 1 - Can Lysol 10+ Biohazard Bags 1 - Container Disinfectant Wipes 1 - Purel
1. Tag #
Section 14: Under Airway Seat
1. 1 - Bed Pan
Yes
No
N/A
2. 1 - Urinal
Yes
No
N/A
3. 1 - Case of water
Yes
No
N/A
Section 15: Interior
1. Drug Box Tag #
Section 16: Cockpit
1. 2 Pens
Yes
No
N/A
2. 2 White Oak EMS Quick Registration Forms
Yes
No
N/A
Section 17: Monitor Top Pocket - 4 misc cuff sizes (infant,pedi,small,large) Left Pocket - Pulse Ox Cable, Leads, Adult Cuff Right Pocket - Therapy Cables, Pedi Combo Pads, 12 Pedi Electrodes, Roll Paper, 2 ET CO2 Circuits, 1 Nasal ET CO2 Circuit Rear Pocket - 2 Adult Quick Combo Pads, Razor, 12 lead cables, 6 packages adult electrodes, 1 Blue Tooth
1. Spare Battery
Yes
No
N/A
2. Canister with Tubing
Yes
No
N/A
3. 2 Yankauer's
Yes
No
N/A
4. 8 French
Yes
No
N/A
5. 10 French
Yes
No
N/A
6. 12 French
Yes
No
N/A
7. House Bag Top Tag #
8. Front Tag #
9. Right Tag #
10. Left Tag #
11. Back Tag #
12. Red Seal in Tact
Yes
No
N/A
Section 18: Oxygen Bag 1 NRB 1 Nasal Cannula 1 Nebulizer 1 Glucometer w Supplies 2 Albuterol's 2 Atrovent
1. Oxygen PSI
2. Pulse Ox Present and Working
Yes
No
N/A
3. Stethoscope
Yes
No
N/A
4. BP Cuff
Yes
No
N/A
5. Personal CO Detector Present & Working?
Yes
No
N/A
6. DRUG BOX TAG #
No answer provided.
Section 19: Under the Bench Seat
1. 1 Full Arm Splint
Yes
No
N/A
2. Half Arm Splint
Yes
No
N/A
3. Foot/Ankle Splint
Yes
No
N/A
4. Full Leg Splint
Yes
No
N/A
5. Half Leg Splint
Yes
No
N/A
6. Hand/Wrist Splint
Yes
No
N/A
7. 1 Full E Cylinder with CPAP Connection
Yes
No
N/A
8. PSI
9. 1 - Case Bottled Water
10. 1 Bottle of Cleaning Wipes
Yes
No
N/A
Section 20: Exterior Rear Passenger Side Compartment
1. Tool Box Tag #
No answer provided.
2. Smart Triage/Red Duffle Bag Tag #
3. 2 - Helmets
Yes
No
N/A
4. 1 -Chemical Approach Duffle Kit
Yes
No
N/A
5. Chemical Approach Duffle Kit Tag #'s
Section 21: Exterior Front Drivers Side Compartment
1. 1 - KED
Yes
No
N/A
2. 1 Reeves Stretcher
Yes
No
N/A
Section 22: Exterior Middle Drivers Side Compartment
1. 2 Helmets
Yes
No
N/A
2. 2 sets of turn out gear
Yes
No
N/A
Section 23: Exterior Rear Drivers Side Compartment
1. 1 Long Board with straps
Yes
No
N/A
2. 1 - Stairchair
Yes
No
N/A
3. 1 Scoop Stretcher
Yes
No
N/A
4. 2 sets of CID's with straps
Yes
No
N/A
5. 1 Collar Bag containing 6 collars, 1 of each size
Yes
No
N/A
6. 5 - 9ft straps on door
Yes
No
N/A
Section 24: Collars on Door
1. Infant
Yes
No
N/A
2. Pedi
Yes
No
N/A
3. No Neck
Yes
No
N/A
4. Short
Yes
No
N/A
5. Regular
Yes
No
N/A
6. Tall
Yes
No
N/A
Section 25: ALS Drawer
1. Monitor Battery
Yes
No
N/A
2. Monitor Paper
Yes
No
N/A
3. MAD Device
Yes
No
N/A
4. 1000 NSS
Yes
No
N/A
5. 20 Drip
Yes
No
N/A
6. 2 - Flushes
Yes
No
N/A
7. 2 - IV Caps
Yes
No
N/A
8. D-50
Yes
No
N/A
9. D-50 Expiration Date
10. Alcohol Wipes
Yes
No
N/A
11. 2 - Nebulizers
Yes
No
N/A
12. 2 - NRB
Yes
No
N/A
13. 2 - Nasals
Yes
No
N/A
Section 26: IV Caths
1. 2 - 20ga
Yes
No
N/A
2. 2 - 18ga
Yes
No
N/A
3. Lancets
Yes
No
N/A
4. Arm Board
Yes
No
N/A
5. Electrodes
Yes
No
N/A
6. Tape
Yes
No
N/A
7. OpSites
Yes
No
N/A
8. 4 - Albuterol
Yes
No
N/A
9. IV Start Kit
Yes
No
N/A
10. IV Extension Set
Yes
No
N/A
11. 1 - Cold Pack
Yes
No
N/A
Section 27: MORNING DECON
1. Morning DECON Performed
Yes
No
N/A
2. Truck Clean
Yes
No
N/A
3. New Damage
Yes
No
N/A
4. Exterior Lights Working
Yes
No
N/A
Section 28: Temperatures
1. Comments/Deficiencies/Suggestions
2. Crew Member #1
3. Crew Member #2