Nexus

Formed AI

SOMERSET-PULASKI COUNTY EMS

DAILY VEHICLE INSPECTION

Date Completed

Employee *

EC Units *

Mileage *

Employee *

DOCUMENTS

Vehicle Registration *

Yes

Proof Of Insurance *

Yes

Clip Board & Forms *

Yes

Hazmat Book *

Yes

OXYGEN LEVEL

Large Tank

Small Tank

Small Tank (Spare)

FLUID LEVELS

Brake Fluid

Engine Coolant

Oil Level

Power Steering Fluid

Transmission Fluid

Fuel Level

TIRE PRESSURE/WEAR

Right Front Tire

Right Rear Inside Tire

Right Rear Outside Tire

Left Front Tire

Left Rear Inside Tire

Left Rear Outside Tire

PATIENT COMPARTMENT

UHF Radio:

Transmits

Yes

Receives

Yes

A/C & Heat

Yes

Overhead Lights:

Bright *

Dim *

Florescent *

FLUID WARMER

Fluid Warmer

Yes

Normal Saline

Lactated Ringers

EQUIPMENT SEAL NUMBERS

Air Splints

Blue C-Collar Bag

K.E.D

K.E.D. #2

Sager Splint

Hare Traction

Yellow Med Kit *

Fluid Res Kit *

Pediatric Kit *

Pediatric Kit #2 *

CPAP & Circuit *

Splint Kit *

Fever Kit

SUPPLY CABINET SEALS

Cabinet A *

Cabinet B *

Cabinet C *

Cabinet D *

Cabinet E *

GLOVES

1-Small

Yes

1-Medium

Yes

1-Large

Yes

1-Ex-Large

Yes

TRAUMA KIT

Trauma Kit Inside Seal

Outside:

2-Cat Tourniquets

Yes

1-Trauma Shears

Yes

2-Pair Gloves

Yes

NARCOTIC KIT

Narcotic Kit *

Yes

Narcotic Kit Number *

Kit Seal Number

Morphine1

Morphine 2

Morphine 3

Morphine 4

Ativan 1

Ativan 2

Ativan 3

Ativan 4

Fentanyl 1

Fentanyl 2

Toradol

Ketamine

Versed 1

Versed 2

ALS Transport DVI

SOMERSET-PULASKI COUNTY EMS

DAILY VEHICLE INSPECTION

UHF Ratio:

Windshield Wipers:

Emergency Lights:

Flood Lights:

Oxygen Regulators (X2):

Wall Mounted Thermometer:

Wall Mounted:

Portable:

UHF Radio:

Overhead Lights:

Right:

Front:

Outside:

TOP POUCH:

MIDDLE POUCH:

BOTTOM POUCH:

MOLLE MODULES:

Attachments