Vehicle Check

If you are feeling ill or exhibiting flu like symptoms contact your Shift Superintendent immediately and apply a mask! 🤢😷

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* 1. Date

Date

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* 2. Shift and Station Assignment

  Shift: Station
Pick One

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* 3. Paramedics

  Paramedic 1 Paramedic 2
Pick from drop down menu

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* 4. If third party ride out with crew enter name and reason/position here.

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* 5. Vehicle Information, Mileage and Hour Meter

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* 6. Communications
Check all that are present and perform radio check with dispatch (portables, main radio and pt compartment). Record any missing equipment on maintenance report at end of report.

  Yes No
Main Radio
Patient Compartment
Portable Radio #1
Portable Radio #2

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* 7. Accessory Equipment

  Yes No
Fire Portable
Vehicle Cell Phone
Garage Door opener
Hospital Gate opener
Laptop charging cord (AC and DC) (AC in charger bag)
Defib charging cord (in charger bag)
Suction charging cord (in charger bag)
Cellphone Charger (in charger bag)
Glucometer Charger (in charger bag)

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* 8. Engine Compartment Inspection
1)Check engine oil
2)Check power steering fluid
3)Check brake fluid
4)Check transmission fluid
5)Check engine coolant (cold engine only)
6)Check windshield fluid
7)Check hoses and clamps
8)Check for fluid leaks

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* 9. Inside Cab Inspection
1)Fuel above 3/4
2)Feel of brake pedal
3)Test parking brake
4)Seats and safety belts
5)No chips cracks in windshield, windows and mirrors
6)Check all gauges
7)Start engine
8)Check steering wheel for play
9)Heater/AC operational
10)Ownership and Insurance slips present
11)Collision form package present
12)Fuel book and gas cards present
13)Horn/siren functioning
14)Cab interior is clean
15)Fire extinguishers present (2) and Battery-Operated Flares present (4)
16) Seatbelt visual inspection, check for fraying, cuts, or tears in the belt material. Look for signs of wear or damage on the buckle and latch. Check that the belt retracts smoothly without sticking

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* 10. Outside Cab Inspection
1)Check for damage
2)Headlights - High Beam, Low Beam functional
3)Running/Parking lights
4)Back-up alarm and lights
5)Overhead clearance lights
6)Turn signals and four-way flashers
7)Brake lights
8)Tires and Air pressure
9)Wipers, Windshield Washer functional
10)Primary emergency lights
11)Secondary emergency lights
12)Scene lights
13)Directional arrow (if equipped)

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* 11. Vehicle or Personal Issue equipment
1)Helmets - 2
2)High Visibility Vests - 2
3)Protective Safety Eyewear - 2
4)Rainsuits -2
5)Lifejackets - 2
6)Map books
7)Zip pack and ACRs
8)Flashlights - 2
9)Kleenex - 2
10)Antiseptic hand cleaner - 1 (check expiry)
11)Oxygen D cylinders - 2
12)Sager splints - 1
13)Speed splints - 2
14)Backboards - 2
15)KED - 1
16)Canvas and pole
17)Scoop stretcher and straps
18)Stairchair

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* 12. Oxygen
Oxygen M tank pressure is greater than 500psi.
Oxygen D tank pressure is greater than 1000psi

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* 13. Spinal Bag
Adjustable Adult Cervical Collar - 3
Adjustable Peds Cervical Collar - 3
Quick connect Straps - 8
Tape 2 inch - 2
Tape 1 inch - 1
Triangulars - 4

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* 14. Trauma Bag -(bag number matches vehicle)
**Does the bag appear in good condition, Check expiries for...
1)Abdominal Dressings - 4,
2)Tape Regular 1" - 2
3)Tape Regular 2" - 2
4)Tape Hypoallergenic 1" - 2
5)Tape Hypoallergenic 2" - 2
6)Band-Aids - 10 individual
7)Cold Packs - 1
8)Emesis Bag - 2
9)Foil Blanket - 2
10)Kling 4" - 3
11)Kling 6" - 3
12)4x4 Dressing - 10 individual
13)Gloves Small - 2 Pair
14)Gloves Medium - 2 Pair
15)Gloves Large - 2 Pair
16)Gloves X-Large - 2 Pair
17)Hand Sanitizer (check expiry) - 1
18)Hot Pack - 1
19)Sterile Water - 1000mL
20)Pressure Dressing Small - 2
21)Pressure Dressing Large - 2
22)Scissors - 1
23)Malleable Spline - 1
24)Triangulars - 6
25)Hemostatic Dressing - 2
26)Arterial Tourniquet - 1

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* 15. Oxygen Bag-(bag number matches vehicle)
**Does the bag appear in good condition
1)D tank and regulator
2)CPAP Mask Red (small) - 1
3)CPAP Mask Blue (large) - 1
4)High Conc/Low Flow (Flowmax Isolation) Adult Mask - 1
5)High Conc/Low Flow (Flowmax Isolation) Pediatric Mask - 1
6)Nasal Cannula - 1
7)Nasal Cannula with ETCO2 - 1
8)Adult NRB - 1
9)Pediatric Simple - 1
10)Oxygen Tubing - 1
11)Adult Nebulizer Mask - 1
12)Pediatric Nebulizer Mask - 1
13)Adult BVM with Stack - 1
14)IGEL Holder (Tommy Tube Holder) - 1
15)IGEL Sizes 3, 4, 5
16)OPA Sizes 5, 6, 7, 8, 9, 10, 11cm
17)Lubricant
18)NPA Size 26, 30, 34
19)Suction Tubing Kit - 1
20)Suction French Catheter sizes 5/6, 10, 14
21)Portable Suction Unit

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* 16. Symptom Relief Bag -(bag number matches vehicle)
**Does the bag appear in good condition
Check Expiries for -
1)Alcohol swabs - 10 individual
2)Needle 25G 1.5" - 4
3)Needle 25G 5/8" - 4
4)Needle 22G 1" - 4
5)Syringe 1mL - 4
6)Syringe 3mL - 4
7)Syringe 10mL - 4
8)Blunt Needle - 4
9)BP Cuff Adult
10)Stethoscope
11)Water + Straw - 2
12)Shears - 1
13)Hand Sanitizer (check expiry) - 1
14)IV Kit (check expiries and tag) - 1
15)Buretrol Set
16)Pressure Infuser
17)Dextrose D10 - 2
18)Glucagon - 2
19)Nasal Glucagon - 2
20)Oral Glucose - 2
21)Glucometer - 1
22)Lancets - 10 lancets
23)Alcohol Swabs - 5 individual
24)Glucose Test Strips - 10 individual
25)ASA - 3 Packages
26)Nitroglycerine - 2
27)Acetaminophen - 3 packages
28)Ibuprofen - 3 packages
29)Ketorolac - 2
30)Ventolin 2.5mg Neb - 3 packages
31)Ventolin MDI - 2
32)MDI Aero Chamber - 2
33)MDI BVM Adapter - 2
34)Diphenhydramine - 2
35)Dimenhydrinate - 2
36)Epinephrine - 10
37)Naloxone - 12
38)Nasal Atomization Device - 2
39)Dexamethasone - 2
40) TXA - 2
41)Oxytocin - 1
42)Ondansetron - 2

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* 17. *Pediatric Bag (bag number matches vehicle)
**Does the bag appear in good condition
1)OB Kit - 1
2)Pediatric Cervical Collar - 1
3)Blanket - 1
4)Toy - 1
5)Sp02 - 1
6)Oral Airways size 5, 6, 7, and 8 - 1 each
7)Nasal Airway and Muco Gel 26Fr - 1
8) IGel Size 1, 1.5, 2, 2.5, 3 and IGel Holder - 1 each
9) 1" Clear Tape - 1
10) Suction Tubing size 6 Fr (1)
11)IV Buretrol set - 1
12)Broselow Tape - 1
13)Reference Cards - 1
14)Peds Electrodes - 2 packages
15)IV Drip Set - 1
16)Band-aids 10
17)Stickers
18)Child BVM W Filter - 1
19)Infant BVM W Filter - 1
20)Peds 02 Masks Simple - 2
21)Peds High Con/Low flow Tavish or Flomax - 1
22)Peds Ventolin mask - 2
23)Biohazard bag - 1

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* 18. Monday morning record glucometer high and low checks

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* 19. ZOLL X Series Defibrillator (unit number matches vehicle)
Unit clean and case intact.
Turn unit on, Start up tones heard and red, green, yellow visual alarm indicators illuminate.
"SELF TEST PASSED" displayed on screen.
Multifunction cable connected to test connector and charged to 30 J. "DEFIB SHORT TEST PASSED" displayed.

Supplies present:
1)Adult Defib Pads - 2
2)ECG electrodes 4's - 2 packages
3)ECG electrodes 6's - 2 packages
4)ECG Paper - 1 Roll
5)Razors - 2
6) Towel/Shears Kit - 1
7)4 lead & 12 lead cables
8)Defibrillation cable with grey adaptor
9)SpO2 Adult
10)Peds Spo2
11)Large Adult, Small Adult, & Peds NIBP cuffs - 1 each
12) Batteries(1 unit, 1 spare)
13)Thermometer
14) Thermoscan ear covers - 1 box
15)Peds Defib Pads - 1
16)BP Cuff Flexport (black, to go on BP Cuff for washing) - 1
17)Drager CO monitor LED screen readable and intact

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* 20. Interior Compartments are tagged, signed and dated.

If any deficiencies or problems are found, please notify the Shift Superintendent and fill out a Maintenance Request Form.

Vehicle Maintenance Form: https://intranetwa.brucecounty.on.ca/intranet/maintenance-request-form/

General Maintenance Form: https://intranetwa.brucecounty.on.ca/intranet/general-maintenance-request-form/

Thank you.
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