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NERA Daily BLS Medication Checklist
Today's date:
*
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Month
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Day
Year
Date Picker Icon
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:
Hour
00
10
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50
Minutes
Crew 1 Last Name
*
Crew 2 Last Name
*
Truck #
*
Please Select
2
14
20
22
24
26
28
40
42
44
46
48
50
Other
Medication and Supply Expiration Dates
Please record the expiration date of all meds in your drug box.
Albuterol
*
Baby Aspirin 81mg -1
*
Epi-2
*
Oral Glucose - 4
*
Narcan - 2
*
Zoll Defib Pads Adult - 2
*
Zoll Defib Pads Pedi - 1
*
Zoll AED Serial Number
*
Zoll AED Status Check Result
*
Please list any expired or missing meds:
Final
BLS Drug Box Checklist Result
*
Unsatisfactory (Notify Dispatch Immediately)
Satisfactory
MA EMT # of Person Completing Form
*
Submit Checklist
Should be Empty: