ALS Monthly Inspection

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Formed AI

ALS MONTHLY INSPECTION

Date

EC Units *

Mileage *

VEHICLE

CLEANED

REPAIRS

INTERIOR CAB

Cleaned *

Repairs *

INTERIOR BOX

Cleaned *

Repairs *

EXTERIOR CAB

Cleaned *

Repairs *

EXTERIOR BOX

Cleaned *

Repairs *

CABINETS

OLD SEAL

NEW SEAL

UNIT #

A

OLD SEAL *

NEW SEAL *

UNIT # *

B

OLD SEAL *

NEW SEAL *

UNIT # *

C

OLD SEAL *

NEW SEAL *

UNIT # *

D

OLD SEAL *

NEW SEAL *

UNIT # *

E

OLD SEAL *

NEW SEAL *

UNIT # *

ALS BAG

OLD SEAL

NEW SEAL

UNIT #

CENTER

OLD SEAL *

NEW SEAL *

UNIT # *

LEFT POCKET

OLD SEAL *

NEW SEAL *

UNIT # *

RED MED

OLD SEAL *

NEW SEAL *

UNIT # *

KITS

OLD SEAL

NEW SEAL

UNIT #

YELLOW

OLD SEAL *

NEW SEAL *

UNIT # *

FLUID

OLD SEAL *

NEW SEAL *

UNIT # *

TRAUMA

OLD SEAL *

NEW SEAL *

UNIT # *

PEDIATRIC

OLD SEAL *

NEW SEAL *

UNIT # *

FEVER

OLD SEAL *

NEW SEAL *

UNIT # *

SPLINT

OLD SEAL *

NEW SEAL *

UNIT # *

EQUIPMENT

OLD SEAL

NEW SEAL

UNIT #

KED 1

OLD SEAL *

NEW SEAL *

UNIT # *

KED 2

OLD SEAL *

NEW SEAL *

UNIT # *

HARE

OLD SEAL *

NEW SEAL *

UNIT # *

SAGER

OLD SEAL *

NEW SEAL *

UNIT # *

KTD

OLD SEAL *

NEW SEAL *

UNIT # *

AIR SPLINTS

OLD SEAL *

NEW SEAL *

UNIT # *

C-COLLAR BAG

OLD SEAL *

NEW SEAL *

UNIT # *

TOOL BOX

OLD SEAL *

NEW SEAL *

UNIT # *

MONITORING DEVICE

OPERATIONAL

CORRECT PADS

ALL CABLES

LIFE PAK

OPERATIONAL *

CORRECT PADS *

ALL CABLES *

SUCTION

OPERATIONAL *

CORRECT PADS *

ALL CABLES *

Person(s) To Be Notified (use A Comma To Separate Email Addresses; Do Not Add a Space After the Comma)

Notes *