Truck Check Sheet

Date*
MM slash DD slash YYYY
Unit #*
Shift*
Crew*
** + Should be used with a number to indicate quanities needed (EX: + 3) / - Should be used with a number to indicate overstock that YOU HAVE REMOVED (EX: -3) **
Compartment 1 | Reg. (+/-)
Hydrogent Peroxide | 1
Sterile H20 | 1
Emerg. Blanket | 2*
OB Kit w/ Silver Swad | 1*
Bulb Syringe | 1*
Multi-trauma Pads | 2*
Burn Sheets | 2*
Pink Slip (Patient Movement Sys) | 2*
Thermometer | 1*
Thermometer Covers | 1 bx*
Compartment 2 | Reg. (+/-)
Adult NRB | 2*
Adult NC | 4*
Pedi NRB | 2*
Pedi Neb | 2*
CPAP Mask | 1
Compartment 3 | Reg. (+/-)
Convenience Bags | 4*
Alcohol Preps | 1 bx*
Band-Aids | 1 bx*
Tape 1" | 2*
Tape 2" | 2*
Cold Packs | 1
Pedi Wheel / Broselow | 1*
O2 Wrench | 1*
Ring Cutter | 1*
Trauma Shears | 2*
Pen Light | 1*
Arterial Tourniquet | 1*
OPA Set (Sizes 1-6) | 1*
Stethoscope (Double Bell) | 1*
Xlarge BP Cuff | 1*
Adult BP Cuff | 1*
Child BP Cuff | 1*
Infant BP Cuff | 1*
Buretrol Tubing Set | 1
Dial-A-Flow Drop Set | 1
10 gtts Drop Set | 2*
60 gtts Drop Set | 2*
Normal Saline (1000cc Total)
Adult BVM | 2*
Child BVM | 1*
Infant BVM | 1*
Compartment 4 | Reg. (+/-)
Biohazard Bags | 5*
Isolation kit | 3*
Safety glasses | 3*
N95 Face Mask | 3*
Kerlix Rolls | 12*
Triangular Bandage | 12*
2" & 4" Ace Bandage | 1 ea
Vaso Gauze (3x8") | 6*
Sterile 4x4s | 60*
Manual Portable Suction | 1*
Suction Canister | 1*
Suction Tubing | 1*
Yankeur Tip | 1*
French Tip Cath 8 FR | 2*
French Tip Cath 10 FR | 2*
French Tip Cath 14 FR | 2*
Sheets | 2*
Blankets | 2*
Towels | 2*
Medium Gloves | 1*
Large Gloves | 1*
Compartment 5 | Reg. (+/-)
Accident Packet | 2*
Triage Tags | 1 pk*
Jumper Cables | 1*
Flash Light | 2*
Spare Batteries for FL | 2*
Reflective Vest | 2*
Emergency Triangles | 3*
IMMobilization Kit | Reg. (+/-)
Adult C-Collar (Adjustable) | 2*
Pedi C-Collar (Adjustable) | 2*
Traction Splint (KTD) | 1*
Bench Seat | Reg. (+/-)
Board Splint (15" x 3") Sm | 2*
Sam Splint to Substitute 15" Board Splint | 2 ea
Board Splint (36" x 3") Med | 2*
Board Splint (48" x 3") Lg | 2*
KED | 1*
Action Area | Reg. (+/-)
Penlight | 1*
Trauma Shears | 1*
Tape 1" | 2*
Tape 2" | 1*
O2 Wrench | 1*
O2 Gaskets | 2*
Emesis Bags | 4*
Adult Nasal Cannula | 4*
Adult Non-Rebreather | 2*
Adult Nebulizer | 1*
Oral Glucose | 2*
ASA | 1*
Albuterol | 2*
Yankhaur Tip | 1*
Suction Tubing | 1*
Sterile H20 | 1*
8,10,12, or 14 French Suction Cath | 1*
Thermometer | 1*
Thermometer Covers | 1 bx*
Sterile 4x4 | 8*
Non-sterile 4x4 | 1 bg*
Kerlix | 2*
Saline Locks | 4*
Saline Flush | 4*
Vehicle
- TDSHS License
- State Inspection
- Current Registration
- Copy of Insurance
- GPS Unit or applicable Key Maps
- DOT Emergency Response Guide
- Functioning 2 way Radio or Cellular Phone
- Functional Headlights
- Functional Taillights
- Functioning Brake Lights
- Functional Turn Signals
- Functional Emergency Lights
- Functional Back up lights
- Functional Siren
- Audible Back Up Device
- Functioning Horn
- Functioning Dome Lights (high/low)
- All Doors Function
- Functional Seatbelts
- Functions HVAC (Front & Rear)
- No Smoking Sign (Front & Rear)
- 5lb. ABC Extinguisher (Front) Mounted
- 1 Quart ABC Extinguisher (Rear) Mounted
- Tires in good repair
- Running boards or Steps
- Leak free side exhaust
- Un-illuminated Check Engine Light
Sanitation / Protection | Reg. (+/-)
Sharps ontainer (Mounted) | 1*
Bio Hazard Bags | 5*
Trash can w/ disposable liners | 1*
Disposable cleaning supplies | 1*
Hand Sanitizer | 1*
Oxygen | Reg. (+/-)
Main O2 (MIN: 500 PSI) | 1*
Spare Portables | 2*
Portable O2 w/ Regulator (MIN: 800 PSI) | 1*
Tag Numbers
Compartment 1
Compartment 2
Compartment 3
Compartment 4
Compartment 5
IMMobilization Kit
CAPTCHA

Compartment 1 | Reg. (+/-)

Compartment 2 | Reg. (+/-)

Compartment 3 | Reg. (+/-)

Compartment 4 | Reg. (+/-)

Compartment 5 | Reg. (+/-)

IMMobilization Kit | Reg. (+/-)

Bench Seat | Reg. (+/-)

Action Area | Reg. (+/-)

Sanitation / Protection | Reg. (+/-)

Oxygen | Reg. (+/-)

Tag Numbers