Ambo 395 Checklist A395 Checklist Exterior/Engine Is this Frontline 395 or a Reserve? * Frontline 395 Reserve What Reserve? (Unit Number) * Engine Oil * Overfill Within Normal Fill Range Needs Oil Engine Coolant * Overfill Within Normal Range Needs Coolant Brake Fluid * Overfill Within Normal Range Needs Fluid Emergency Lights * All Working Burned Out/Broken Lights Tires * Good Condition Damaged Balding Flat Which Tire(s)? * Dump System * Dumps Does Not Dump Exterior Body * No New Damage New Damage (Upload Photos at End of Checklist) Note Corrective Actions Taken and Any New Damage Unit Cab Current Mileage * Check the Service Due Sticker on the Windshield. Does the unit mileage exceed the Next Service Due milage on the sticker? Please only go by this and NOT by the dashboard Service Due Warning. * Unit does not require service at this time. Odometer exceeds Next Due Service Milage Fuel Level * Full 3/4 1/2 1/4 Empty DEF Level * Full 3/4 1/2 1/4 Empty CAB Cleanliness * Clean Dirty Knox Box Key * Present Missing In Reserve Unit Fuel Card Present * Present Missing Damaged 2 Radios with Lapel Microphones in Charges Yes 1 Lapel Missing 2 Lapel Missing Radios Not in Charger 1 Radio Missing 2 Radios Missing Exterior Main O2 Level * Spare Extension Cord and Shore Line Adapter Present * Yes No In compartment with cooler Number of Standard Backboards * Collar Bag Stocked * Yes No Note Items Used to Restock Orthopedic/Scoop Stretcher Present * Yes No Reeves Present * Yes No Stair Chair Present * Yes No Driver SCBA Above 4,000PSI * Yes No On Loan for Classes Officer SCBA Above Above 4000psi * Yes No On Loan for Classes Patient Compartment IV Drawer Stocked * Yes No Note Items Used to Restock Monitor Stocked and Charged * Yes Needed Restocking Not Charged Note Items Used to Restock Any Expired Drugs in Drawer? * Yes No Note Expired Drugs and Expiration Dates CDS Audited (ALS Only) * Yes No BLS Crew BVMs Present (Check all that apply) * Adult Pediatric Infant Airway Bag Stocked (ALS Only) * Yes No BLS Crew-Bag Is Physically Present BLS Crew-Bag Is Missing O2 Bag Stocked * Yes No O2 Bag should have Oxygen Bottle, Adult and Peds Nasal Canula, NRB, Nebulizer Kit and BLS Airway adjuncts. Note Items Used to Restock Littman Stethoscope Present * Yes No Thermometer Present and Working * Yes No Suction Stocked and Charged * Yes No Stretcher Battery Charged * Yes No Laptop Charged * Yes No Raptor Trauma Sheers Present in Black and Red Bags * Yes No Stretcher O2 Level * 2000-1500 PSI 1500-1000 PSI 1000-500 PSI 500-0 PSI O2 Bag Bottle Level * 2000-1500 PSI 1500-1000 PSI 1000-500 PSI 500-0 PSI #1 Spare O2 Bottle Near Door * Green Tag (Full) Red Tag (Empty) No Tag #2 Spare O2 Bottle Near Door * Green Tag (Full) Red Tag (Empty) No Tag Black Bag Upper Exterior Drug Pouch (SELECT ONLY THE MISSING DRUGS) * 1 Bottle Asprin 4 Vials Albuterol 2 Vials of 1MG Epi 2 Atomizers 4 Vials of Narcan 6 Vials of Zofrans 2 Vials of Benadryl 2 Vials of Atrovent 1 Vial of Toradol 1 Vial of Triperidol 2 Vials of Dexamethasone 2 Vials of Terbutaline 5 Vials of Amioderone 1 Multi-Dose Epi Bottle 1 Magnesium Sulfate Bottle 5 vials of Adenosine 1 bottle of Nitro tablets 1 blister pack of Nitro paste 1 vial of TXA 1 glucagone kit 1 BLS Epi-Kit All Medicines Present in Correct Amounts Lower Exterior Pouch * IV Kit Stocked-Contains 2 of Each Syringe and IV Size plus supplies. Pulse Ox Functional Pulse Ox Not Functional Stethoscope Present Stethoscope Damaged or Missing BP Cuff Present BP Cuff Damaged or Missing Glucometer Present and Stocked Glucometer Presented and Not Stocked Glucometer Missing Interior Diabetic Module * 2 Oral Glucose Pastes 1 10% Dextrose 1 Macro Drip Set Missing-1 or More Oral Glucose Pastes Missing-10% Dextrose Missing-Macro Drip Set Minor Trauma Module * 4x4s Kravats Ice Packs Kling Missing-4x4s Missing-Kravats Missing-Ice Packs Missing-Kling Major Trauma Pouch * 2 Tourniquets Chest Seals Israeli Bandage Missing-Chest Seals Missing-Israeli Bandage Missing-1 or More Tourniquets ACLS Drug Pouch * 6 Boxes of ALS Epi 1 Calcium Carbonite 1 Atropine 1 Bicarb Missing-1 or More Boxes of ALS Epi Missing-Calcium Carbonite Missing-Atropine Missing-Bicarb Yellow Drip Module * 3 Normal Saline 1 Macro Drip Set 1 Micro Drp Set 1 Diltiazem Missing- One or More Normal Saline Missing- Macro Drip Set Missing- Micro Drp Set Missing- Diltiazem General Bag Items * Trauma Dressing Emesis Bags Ice Packs 1 Adult BVM 1 Sharps Container CO Monitor 1 Lactated Ringers Missing- Trauma Dressing Missing-Emesis Bags Missing-Ice Packs Missing- Adult BVM Missing- Sharps Container Missing-CO Monitor Missing- Lactated Ringers Additional Information Number of N95 Small Masks Number of N95 Regular Masks Number of Gowns Any other issues or problems with unit or equipment Crew Information Crew Member 1 * Crew Member 2 * Crew Member 3 Date * Shift * AM PM Both AM and PM Overnight Staffing Level * BLS ALS Upload any Photos of Damage to Unit, Equipment or documentation of concerns or complaints with unit. 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