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NERA Daily ALS Equipment Checklist
Date
*
Crew Last Name
*
Crew Last Name
*
Truck #
*
Please Select
2
20
40
42
44
46
48
51
52
53
54
55
56
57
Unit
*
Please Select
P-1
P-2
P-3
P-4
P-5
P-6
P-7
P-8
P-9
Other
Cab Area
Cab Area
*
Fail
Pass
Items Missing
Beverly Street Guide
Toughbook w/changer
(1) Portable Radios
(2) ANSI Safety Vests
Forward Passenger Exterior Cabinet
Is this area stocked completely?
*
Please Select
Fully stocked
Missing equipment
Items missing?
Broslow Bag w/tape (sealed)
CPAP/Vent Bag (sealed)
Ventilator w/charger
Oxygen Bag
Is this area stocked completely?
*
Please Select
Fully stocked
Missing equipment
Items missing?
Tank w/regulator
O2 Wrench
(2) Adult canula
(2) Adult NRB
(2) Pedi Canula
(2) Pedi NRB
Nebulizer
O2 Tank PSI Remaining
*
Portable Suction
Is this area stocked completely?
*
Please Select
Fully stocked
Missing equipment
Items missing?
Portable Unit w/charger
Suction Cath 6Fr
Suction Cath 8 Fr
Yankhauer w/tubing
Suction Cath 10 Fr
(2) face/eye shield
(2) Pair Gloves
C-spine Bag
Is this area stocked completely?
*
Please Select
Fully stocked
Missing equipment
Items missing?
(3) Pedi Collars
(3) Occiput Pads
(4) Adult Collars
(2) Rolls 2" Tape
(9) 9' Straps
(2) Sets Headblocks
Cardiac Monitor
Is this area stocked completely?
*
Please Select
Fully stocked
Missing equipment
Perform Defib Test @ 30J
*
Fail
Pass
Items missing?
Wall Charger
Spare Battery
ETCo2 Nasal Canulas
ECG/12 Lead Cables
ETCo2 ETT Adapter
(2) Razors
ECG Paper
4 /6 Electrodes
Pediatric SpO2 Disposable Probe
ALS First-In Bag
Is this area stocked completely?
*
Please Select
Fully stocked
Missing equipment
Items missing?
Adult BP Cuff
Pedi BP Cuff
Adult BVM
Stethoscope
Sharps Container
OPA Set
NPA Set
Glucometer
(10) Test Strips
(5) Lancets
(10) Band-aids
(2) Tourniquets
(5) 14g IV Cath
(5) 16g IV Cath
(5) 18g IV Cath
(5) 20g IV Cath
(5) 22g IV Cath
(5) 24g IV Cath
1" Plastic Tape
Trauma Pad
(2) 5x9 Pads
(12) 4x4 Gauze
(2) 4" Kling
Burn Sheet
(4) IV Lock Sets
500 mL NaCl
(10) Alcohol Preps
EZ-IO Gun (Do Not Test)
(2) Adult IO Needles
(2) Pedi IO Needles
(2) IO Lock Sets
Pressure Infuser Bag
(2) Face/Eye Shields
Pen Light
(4) Tegederms
(2) Pairs L Gloves
(4) Saline Flushes
Trauma Shears
2" Cloth Tape
(2) Decompression Needles
Intubation Roll
Is this area stocked completely?
*
Please Select
Fully stocked
Missing equipment
Items missing?
ET Laryngoscope Handle
(2) Tube Holders
Yankhauer w/tubing
Mac 3 Blade
Magill Forceps
Mac 4 Blade
(2) Surg Lube
1" Plastic Tape
Miller 3 Blade
ET Tube Size 6
ET Tube Size 6.5
Miller 4 Blade
ET Tube Size 7
ET Tube Size 7.5
(2) 10cc Syringes
ET Tube Size 8
ET Tube Size 8.5
Adult Stylette
ET Tube Size 9
ETCo2 Colormetric Device
Bench Seat
Is this area stocked completely?
*
Please Select
Fully stocked
Missing equipment
Items missing?
(2) 15" Padded Board Splint
(2) 3' Padded Board Splint
(2) 4' Padded Board Splint
Transfer Sheet
Urinal
(2) Waterproof Pillows
Bedpan
Pedi-Mate
Stretcher/Interior
Is this area stocked completely?
*
Please Select
Fully stocked
Missing equipment
Items missing?
Cot w/restraints & IV Pole
Inhouse suction unit w/canister
(2) O2 Regulators
(2) Emesis Bags
Hand Cleanser
Rear Glove Cabinet
Is this area stocked completely?
*
Please Select
Fully stocked
Missing equipment
Items missing?
Box Small Gloves
Thigh BP Cuff
Box Med Gloves
Adult BP Cuff
Box Lg Gloves
Pedi BP Cuff
Box XL Gloves
(2) Box Tissue
Infant BP Cuff
Double Bell Stethoscope
Rear Upper Cabinet
Is this area stocked completely?
*
Please Select
Fully stocked
Missing equipment
Items missing?
(4) Trauma Dressings
BLS Trauma -foil, burn sheet, BSI kits
Sterile OB Kit
(2) Sets Soft Restraints
Disinfectant Wipes
Biozide Spray
Rear IV Cabinet
Is this area stocked completely?
*
Please Select
Fully stocked
Missing equipment
Items missing?
(5) 1L NaCL
(4) Macro Dripsets
(2) 500mL NaCL
(4) Micro Dripsets
(2) 250mL NaCL
(2) Buretrol Sets
Pressure IV Infuser
Working Cabinet
Is this area stocked completely?
*
Please Select
Fully stocked
Missing equipment
Items missing?
Chest Decomp Kit
Needles 5ea 18,21,23,24g
Butterfly 2ea 23,25g
Syringes 3ea 1,3,10cc
(3) 30mL Syringes
Spare Sharps Box
(5) 14g IV Caths
(5) 16g IV Caths
(10) 18g IV Caths
(10) 20g IV Caths
(5) 22g IV Caths
(5) 24g IV Caths
(5) IV Locks
(10) Saline Flushes
(12) 4x4 Gauze
(10) Tourniquets
(25) Alcohol Preps
(2) Arm Boards
(30) Lancets
(10) Tegaderms
Box Glucometer Strips
(4) Rolls 1" Tape
(8) Triangle Bandages
(8) 5x9 Pads
(2) Cold Packs
(2) Drinking Cups
(2) Emesis Bags
Trauma Shears
Pen Light
Ring Cutter
Blood Draw Kit
(2) Morgan Lense
Linen Cabinet/Chair Rack
Is this area stocked completely?
*
Please Select
Fully stocked
Missing equipment
Items missing?
(8) Sheets
(4) Blankets
(4) Towels
Stairchair w/straps
Short Backboard
(4) Pillow Cases
Tech Seat Airway/Monitor Cabinet
Is this area stocked completely?
*
Please Select
Fully stocked
Missing equipment
Items missing?
Pedi ETT 2.0-5.0
Adult ETT 5.5-90
Mac Blades 1,2,3,4
Miller Blades 1,2,3,4
Stylette
(2) Bougie Introducers
(2) Tube Restraints
Scope bulb/battery
(2) ETCo2 Colormetric Devices
NG Tubes 2ea 5,8,10,14 Fr
King LT-D Airway 3
(2) Airtraq Optical Laryngoscope
Kind LT-D Airway 4
King LT-D Airway 5
Suction Cabinet
Is this area stocked completely?
*
Please Select
Fully stocked
Missing equipment
Items missing?
Portable Suction Canister
(3) 1L Sterile Water
Inhouse Suction Canister
(2) Yankhauer w/tubing
(2) Yankhauer w/tubing
Oxygen Supplies Cabinet
Is this area stocked completely?
*
Please Select
Fully stocked
Missing equipment
Items missing?
(4) Adult Nasal Cannulas
(1) Oxygen Humidifier Set
(4) Adult NRB
(4) Pedi Nasal Cannulas
(4) Nebulizer Sets
(4) Pedi NRB
Tech Seatback Shelving
Is this area stocked completely?
*
Please Select
Fully stocked
Missing equipment
Items missing?
Adult BVM w/mask
Pedi BVM w/mask
Infant BVM w/mask
Adult vent circuit
(2) N-95 Mask (sm-med)
Pedi vent circuit
(2) N-95 Mask (med-large)
Binoculars
(2) Large Bio bags w/ties
(2) face/eye shield
(2) Small Bio bags w/ties
External Oxygen Compartment
Is this area stocked completely?
*
Please Select
Fully stocked
Missing equipment
Onboard Tank PSI
*
Items missing?
Oxygen wrench
2 D-size O2 tanks
2 Wheel Chocks
Monitor Tray for stretcher
Exterior Board Cabinet
Is this area stocked completely?
*
Please Select
Fully stocked
Missing equipment
Items missing?
(2) Long Spineboards
Scoop Stretcher
Final
Name of Crewmember submitting checklist
*
Equipment Inspection Result
*
Unsatisfactory (Notify Dispatch Immediately)
Satisfactory
Submit Checklist
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