Lakeland EMS Rig Check

Please complete all fields below. If you require immediate re-stock assistance contact your duty officer.

Ambulance *

Date *

YYYY

Mileage *

Your answer

Fuel Level *

Full

7/8

3/4

5/8

1/2

<1/2

Cab Equipment *

Portable Radio

Tablet (Charging)

Toughbook (Logged In)

Out of Service Sign

Reflective Vests (2)

Paper Clipboard (Stocked)

Triage Tags In Each Door Pocket (2 Packs Total)

GPS

Gate Cards (2)

Garage Door Opener

Binoculars

HazMat Guidebook

Streamlight Flashlights (2)

Required

On-Board O2 PSI *

Your answer

Vehicle Lights/Emergency Warning Devices *

All Flashing Lights Functional (Run Diagnostic Test)

Siren(s) Functional

All Scene Lights Functional

Headlamps & Fog Lamps Functional

Turn Signals Functional

Paper Clipboard (Stocked)

Triage Tags In Each Door Pocket (2 Packs Total)

GPS

Gate Cards (2)

Garage Door Opener

Binoculars

HazMat Guidebook

Streamlight Flashlights (2)

Required

Exterior Compartments *

Slatted Reeves

Life Vests (2)

Rope

Fire Extinguishers (2)

Cribbing

KED

Reeves Sleeve

Helmets (2), Turnout Coats (2), Extrication Gloves (4)

MCI Cones

Tool Box (Hailligan, Crow Bar, etc.)

Traffic Safety Triangles

Rehab Bin

Powerhawk Charged (O-Cutters / Spreader)

Collar Bag Stocked (Min. 3 Adult, 3 Ped., Spiders)

Short Board

Long Boards (Min. 2) with CID/Head Chocks

Scoop

Stair Chair

Required

Blue Jump Bag *

Adult NRB (Min. 3)

Adult NC (Min. 3)

Adult BVM (1)

O2 Tubing

Various OPAs (Sealed)

Various NPAs (Sealed) w. Lube (Check Dates)

Glucose (Check Date)

Aspirin (Check Date)

Tourniquet

Crevats (Min. 2)

Stethescope

Adult BP Buff

Trauma Sheers

Pen Light

Pulse Ox

Assorted First Aid Supplies (Gauze, Roller Gauze, Tape, Band-Aids, Abdominal Pad)

(1) Naloxone & Atomizer (Check Date)

(1) Adult Epi-Pen (Check Date)

O2 Tank (List PSI Below)

Required

Blue Jump Bag O2 PSI *

Your answer

Red Jump Bag *

Ped. NRB (Min. 2)

Ped. NC (Min. 2)

Adult NRB (Min. 2)

Adult NC (Min. 2)

Pediatric BVM (1) & Infant BVM (1)

O2 Tubing

Various OPAs (Sealed)

Various NPAs (Sealed) w. Lube (Check Dates)

Glucose (Check Date)

Crevats (Min. 2)

Stethescope

Pediatric BP Cuff

Adult BP Buff

Trauma Sheers

Pen Light

Tourniquet

Assorted First Aid Supplies (Gauze, Roller Gauze, Tape, Band-Aids, Abdominal Pad)

O2 Tank (List PSI Below)

Required

Red Jump Bag O2 PSI

Your answer

Portable Suction & AED *

AED - Ready

(2) Sets of Adult Pads (Check Date)

(1) Set of Pediatric Pads (Check Date)

Razor

Portable Suction Charged & Functional

Yankauer, Tubing, Soft Tip Suction Catheter (Sealed)

Sterile Water (Check Date)

CPR Board

Required

Interior Equipment *

Stretcher Made

Linens Stocked (Incl. Blanket Warmers)

(2) Full Spare O2 D-Tanks (Outside on 51/53)

Adult O2 - NRB (Min. 5) & NC (Min. 5)n 3

Pedi. O2 - NRB (Min. 5) & NC (Min. 5)

CPAP Mask (Min. 1)

BVMs: (1) Adult, (1) Pediatric & (1) Infant

O2 Tubing

Various OPAs (In Box)

Various NPAs (Sealed) w. Lube (Check Dates)

Glucose (Check Date)

Trauma Sheers, Pen Light, Alcohol Prep Pads, Sting Kit (Check Date)

Assorted First Aid Supplies (Gauze, Roller Gauze, Tape, Band-Aids, Abdominal Pads, Multi-Trauma)

Crevats (Min. 1 Box)

Stethescope & Adult BP Cuff (Action Tray)

BP Cuff Basket: Large Adult, Pediatric, Infant Cuffs

Sterile Water & NaCl (Min. 3 Each / Check Dates)

Hot & Cold Packs (Min. 4 Each)

Naloxone & Atomizer (Check Date)

Epi-Pen (1) Adult & (1) Pediatric Min. (Check Dates)

Aspirin (Check Dates)

Bleeding Control Kit (Check Date)

Burn Kit / Burn Sheets (Check Dates)

Vomit Bags / Basins

(2) OB Kits (Check Dates)

SAM Splint (Min. 1)

PPE, N95 Masks, Safety Goggles, etc.

Sharps Container & Spare Bio-Hazard Bags

Gloves - Small, Med., Large, XL (2 Boxes Each)

Cleaning / Decon Supplies - Wipes, Envirocide Spray (Check Dates)

Required

Bench Seat *

Frac. Pack

Pediatric Immob. Board

Adult Hare Traction (Min. 1) with Ankle Hitch

Pediatric Hare Traction with Ankle Hitch

Padded Board Splints

Required

Additional Comments or Missing Supplies

Your answer

Crew Names *

Your answer

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