Daily Checksheet

Date*
Position in rotation:
Vehicle #*
Shift: *
Crew 1:*
Crew 2:*
Additional Crew:
Fuel Level:*
NYS Inspection Expiration?*
Mileage:*
Registration/Insurance Cards?*
Portable Radios (2): Battery Charged, equipped with mic's*
Maps, Fuel FOB, GPS, HazMat Book?
Safety Vests (2)?
Vehicle lights working properly?*
Emergency lights working properly?*
Siren, Horn, Back-up alarm working properly?*
Driver's compartment HVAC working*
Patient Compartment HVAC working*
All equipment secured?*
Exterior Clean*
Interior Clean?*
Flares (6)? *
Jumper Cables Present?*
Turn-out Jacket & Helmet (1 Set)?*
Fire Extinguisher Expiration date:*
Oxygen M Tank PSI:*
Oxygen D Tank PSI:*
Oxygen- 1 Full, Sealed D Tank?*
Onboard Suction working (tubing/yankauer)?*
Portable Suction (tubing, yankauer, charged)?*
Gurney is made w/Linens?*
Gurney Battery Charged?*
NC, NRB, Emesis Bag, Towel?*
BLS Blue Bag stocked?*
ALS Red Bag Stocked & Locked?*
All cabinets properly stocked?*
Headblocks (3) Collars (3 ea size)?*
Backboards (2) w/ straps (3)?*
iPad charged?*
Comments:
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