Daily Rig Check (ALL) HomeDaily Rig Check (ALL) Daily Rig Check (ALL) ShiftUnit Type(Required)ALS AmbulanceBLS AmbulanceALS Fly CarBLS Fly CarDate(Required) MM slash DD slash YYYY Shift Start Hours : Minutes Crew Member(Required) Crew Member(Required) Trainee/Observer (Optional) VehicleAmbulance(Required)30493059306930793089Fly Car(Required)3031MDT Logged In ALS?(Required) Yes MDT Logged In BLS?(Required) Yes Ambulance Operational(Required) Fuel > 1/2 Fuel FOB & Key FOB present 2 Portable Radios Mobile Radio On 295 Emergency Lights Headlights/Taillights/Turn Signal Select AllFly Car Operational(Required) Fuel > 1/2 Fuel FOB & Key FOB present 1 Portable Radios Mobile Radio On 295 Emergency Lights Headlights/Taillights/Turn Signal Select AllEquipmentGurney Number(Required)BVA1BVA2BVA3BVA4BVA5Gurney Battery Replaced?(Required) Yes Oxygen(Required) D-Tank > 1000 PSI NRB in O2 Sleeve Nasal Canula in O2 Sleeve Select AllOther(Required) Mobile Suction Spare O2 Clipboard stocked Select AllMonitorMonitor #(Required)1234567LS #(Required)1234567Adult Pad Exp(Required) Month Day Year Peds Pad Exp(Required) Month Day Year Monitor/LS Paired(Required) Yes Monitor (LEFT) Reg. Adult BP Cuff Pulse Oximeter Pediatric Pulse Oximeter 3-Lead EKG Cables 12-Lead EKG Cables Select AllMonitor (RIGHT) Adult Capno Peds Capno Inline Capno Monitor Paper Razors Spare Cuffs (3 sizes) Select AllBagsALS Bag #(Required)1234567Seal Item(Required) Next to ExpireExpiration Date(Required) Month Day Year BLS Bag #(Required)BVA 1BVA 2BVA 3BVA 4BVA 5BVA 6BVA 7Bag Contents(Required) ET Kit set Glucometer Manual BP Cuff Pulse Ox Stethoscope Trauma Pocket Side Pockets BVM, NPA, OPA, CPAP Select AllBLS Med Kit #(Required)123Med Kit Seal Item & Date(Required) AED #(Required)123Adult Pad Exp(Required) Month Day Year Peds Pad Exp(Required) Month Day Year Video Scope (Kit # or N/A)(Required)N/AVL1VL2Controlled SubstancesCS Kit #(Required)12345678CS Kit Seal Matches Log?(Required) Yes No CS Discrepancy Explanation(Required)CabinetsCabinets(Required) Airway Sealed Trauma Sealed Linens Present Cleaning Supplies Present Select AllALS Overstock(Required) EKG Stickers IV Starts 10 drip 60 drip Capnography 1L Saline Bag Flushes Sharps Select AllWas the truck found in acceptable condition when you began this check?(Required) Yes No If no, please enter comments below to indicate what you needed to restock/fix/cleanComments/ConcernsIf anything is missing you must contact the shift supervisor ASAP to have them remedy the situation.Do ALL crew members verify the integrity of this check(Required) Yes No