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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)

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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) brake pedal feel, 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 functional, 14) cab interior is clean, 15) fire extinguishers present (2)and flares present (4), 16) Seatbelt visual inspection, check for fraying, cuts, or tears in the belt materials. 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, 3) 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, 10) primary emergency lights, 11) secondary emergency lights, 12) flood lights, 13) directional arrow (if equipped)

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* 11. Vehicle or Personal issue equipment
Helmets(2), High Visibility Vests (2), Protective Safety Eyewear (2), Rainsuits(2), Lifejackets (3), Map books, Zip pack and ACRs, Flashlights(2), Kleenex(2), Antiseptic hand cleaner(1), Oxygen D cylinders (2) Sager splints(1), Speed splints(2), Backboards(2), KED(1), Canvas and poles, Scoop stretcher, 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 Kit
Adjustable cervical collars(2 adult & 2 peds), Quick connect straps(8), Tape 2.5cm(1), Tape 5cm(1), Triangulars(2)

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* 14. First Response Bag -(bag number matches vehicle)
**   Does the bag appear in good condition
1)Abd dressings(2),
2)Hand cleaner(check expiry)(1),
3)Foil blankets(2),
4)Eye pads(2),
5)Gloves(min 2 pr large and extra large),
6)Kling 4"(2) and 6"(1),
7)Paramedic shears(1),
8)Large pressure dressings(2),
9)Quick splint(1),
10)4x4s(4),
11)Sterile water 1000ml( check expiry),
12)Tape 2.5cm (1),
13)Tape 5 cm (1),
14)Triangulars (6),
15) Cold pack(1),
16)Arterial Tourniquet,
17)Hemostatic dressing(2)

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* 15. Oxygen Bag-(bag number matches vehicle)
** Does the bag appear in good condition
D tank and regulator,
CPAP mask (1 small, 1 large)
Peds mask(1),
Adult non-rebreather(2),
Nasal cannula (1),
Oxygen tubing (1)
HIgh Con/Low Flow (Flowmax or Tavish)  1 Adult 1 Ped

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* 16. Symptom Relief Back pack -(bag number matches vehicle)
**Does the bag appear in good condition
Tagged with date and OASIS number or
1)Alcohol swabs (check expiry)(10),
2)ASA(check expiry)(6),
3)Bandaids,
4)Benadryl 50mg(check expiry)(2),
5)Epinephrine 1:1000 1mg/ml (check expiry)(10),
6)Gravol 50mg(check expiry)(2),
7)Gauze(5),
8)Glucagon 1mg(check expiry)(2),
9)Glucometer,
10)Glucometer test strips(check expiry)(10),
11)Lancets(10),
12)Nitroglycerin 0.4mg(check expiry)(2),
13)Oral glucose(check expiry)(2),
14)Syringe 10cc (check expiry)(2),
15)Syringe 3cc (check expiry)(2),
16)Syringe 1cc(check expiry)(2),
17)Needle, 18g with blunt tip (2),
18Needle, 22g 1.5"(2),
19)Needle, 25g 5/8"(2),
20)Needle, 25g 1"(2),
21)Ventolin Neb 2.5mg(check expiry)(10),
22)Ventolin MDI (check expiry)(2),
23)Ventolin aerochamber(2),
24)Ventolin BVM adaptor(2),
25)Adult neb mask(2),
26)Peds neb mask(2),
27)Adult & peds BP cuffs,
28)N95(2),
29)Faceshields(2),
30)Antiseptic Hand Cleaner (check expiry)(1),
31)Stethocope,
32)Dextrose 25g(check expiry)(2),
33)Gloves(4 pr),
34)IV kits(1),
35)Hot pack(1),
36)Sharps container,
37)Ketorolac 30mg/mL(2),
38)Acetaminophen 500mg tablets(6),
39)Ibuprofen 400 mg tablets(6),
40)Naloxone 0.4mg/mL(12),
41)Nasal atomization device(2)
42)Adult BVM mask tubing & virus filter, 
43)King LT Size 3, 4, 5, Tube holder
44)Oral airways(1 each size),
45)Nasal airways(1 each size),
46)Lubricant, water-based(4),
47)Suction, canister, tubing, catheters- size 5/6, 10, 14 (1 each)
48)Flo2 Masks (1 adult, 1 peds)

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* 17. *Pediatric Bag (bag number matches vehicle)
**Does the bag appear in good condition
OB kit (1)
Pediatric C-collar (1)
Blanket (1)
Toy (1)
Sp02 (1)
Oral Airways size 5,6,7,and 8 (1 each)
Nasal Aiway and muco gel  26Fr (1)
King LT Size 3 (1)
Tube holder (1)
Suction Tubing size 6 Fr (1)
IV buretrol set (1)
Broselow Tape x1
Reference Cards x1
Band-aids (few)
Stickers (few)
Child BVM (1)
Infant BVM (1)
Ped's 02 Masks Simple (2)
Ped's High Con/Low flow Tavish or Flomax (1)
Ped's Ventolin mask (2)   

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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.
Connect to Simulator and press VF.
Analyze and shock at 120j.
Supplies present: 1)Multifunction pads(2), 2)ECG electrodes(3 packs of 4 and 2 packs of 6), 3)Recording paper(2), 4)Razor and towel kit(1), 5)4 lead & 12 lead cables, 6)Defibrillation cable with grey adaptor, 7)SpO2 cable, 8)Adult, Large Adult, & Peds NIBP cuffs, 9) Batteries(1 unit, 1 spare), 10)USB memory stick, 11)Thermometer, 12) Thermoscan ear covers (1)
(1) 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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