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Unit Inspection Form
Unit Inspection Form
Date
MM slash DD slash YYYY
Time
:
Hours
Minutes
AM
PM
AM/PM
Medic #
Shop #
Supervisor
Cariota
Adam
Jackson
Parks
Webb
Puerto
Kirkdorffer
Crutchfield
Pagel
Guillote
Tuttoilmondo
Other
Shift
A
B
C
D
Other
In-Charge
Attendant
Third
Comments
Security (cab and patient compartment locked and secured)
Quantity
Price:
$0.01
Quantity
Equipment Accountability (PPE/LUCAS/IV Pump/Ventilator/Traction splint/Scoop/Radios, etc)
Quantity
Price:
$0.01
Quantity
O2 levels (>500 cylinder/>5000 liquid)
Quantity
Price:
$0.01
Quantity
Expirations (Medications/disposable Supplies)
Quantity
Price:
$0.01
Quantity
Cab (Clean and Tidy)
Quantity
Price:
$0.01
Quantity
Exterior (Clean/Washed)
Quantity
Price:
$0.01
Quantity
Patient Compartment (Floors/Trash/Action Area)
Quantity
Price:
$0.01
Quantity
Stat Pack (Par levels/Secured to stretcher)
Quantity
Price:
$0.01
Quantity
Monitor (Secured/batteries charged)
Quantity
Price:
$0.01
Quantity
Daily Chore (completed/in progress)
Quantity
Price:
$0.01
Quantity
Total
$0.00
Supervisor Email
*
In-Charge Email
*
Attendant Email
*
Comments
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