2017 Daily Med Unit Checkoff
Please complete this form at the beginning of your shift.
Unit Identifier *
Date *
MM
/
DD
Crew 1 *
Crew 2 *
Crew 3
Ambulance *
Safety Vests *
Vehicle Fluids *
Oil, Power Steering, Radiator, Transmission, DEF
Fuel Card *
Lighting *
Brake, Head Lamp, Signals, Emergency Lights
Generator Fluids *
Oil
Vehicle Leaks *
Front Tire Condition *
DO NOT CHECK ACTUAL PRESSURE - This will be done by Fleet Maintenance
Rear Tire Condition *
DO NOT CHECK ACTUAL PRESSURE - This will be done by Fleet Maintenance
Outside Equipment *
Stair Chair, Pedi-Mate, Splinting, Scoop, Reeves, LSB's, C-Collar Bag
Fast Splints *
Oxygen *
Cot *
Portable Suction *
Handheld Pulse Oximeter *
Jump Kit *
Monitor *
EKG patches, Ped Pacer pads, Ped Pulse Ox, CHECK TIME ON MONITOR
CPR Stat Padz *
CPR Stat Padz are attached to monitor with proper connector
Glucometer *
Perform Daily Hi/Lo Check
Intraosseous Kit
Thermometer *
Difficult Airway Kit *
1 king vision and its container, 1 channeled and 1 non channeled blade, 1 rigid stylet (which can be cleaned via our CS system), 1 bougie 1 - 7.0 and 1- 8.0 et tube, 1 pertrach kit and 3-4 syringes 3cc -20cc.
Submit
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