Please enable JavaScript in your browser to complete this form.Date / Time Completed *DateTimeUnit *Rescue / Medic 34Rescue / Medic 35GENERAL: *Current State InspectionExterior CleanInterior CleanCurrent VOEMS PermitSeatbelts for AllMeds protected from climate extremesWarning Devices / Tools *Adjustable Wrench, 10" (1)Standard Screwdriver (1)Phillips Screwdriver (1)Center Punch (1)Flares or Cones / Triangles (3)Current USDOT ERG (1)Emergency Lights All SidesMin. 2 Flashing in GrillAudible Warning DeviceMarkings *Agency Contrast / Reflective3" Minimum Lettering4" Minimum Reflective BandCommunications *Vehicle to BaseVehicle to VehicleAIC to Med Control (ALS Only)Safety Equipment *D-Cell Flashlight (1)ABC Extinguisher (5#) (2)Traffic safety apparel (2)Sharps ContainerStretcher w/3 straps min. (1)No Smoking SignLinens: *Towels (2)Blankets (2)Pillows (2)Pillow cases (2)Sheets (4)Male Urinal (1)Bedpan and toilet paper (1)BLS Equipment *AED w/ Set of Pads (2) OR 1 Combination device w/manual optionPocket Masks (2)O/P Airways (6) (Sizes 0 --- 5, 1 ea.)N/P Airways (4) (1 ea of var sizes) Soluble LubeAdult BVM w/ Adult/Peds Mask (1 ea)Infant BVM w/ Infant Mask (1)Oxygen Apparatus: *Portable O2 --- 1150 psi minAdult HC (NRB) Masks (4)Peds HC (NRB) Masks (4) Adult Nasal Cannulae (4) Child Nasal Cannulae (4) Suction Apparatus *Battery Powered Portable SuctionSuction Catheters: Rigid Tonsil Tip, FR 18, FR 14, FR 8, & FR 6 (2 ea.)Patient Assessment Equipment *Adult Stethoscope (2)Peds Stethoscope (1)B/P Cuffs: Child, Adult, LG (1 ea)Vinyl Triage Tape Rolls: Red, Black, Green and Yellow (1 ea)OEMS Approved Triage Tags (25) Penlight (1) Current Medical Protocols (1)EMT-A/ I / P: (EMT-E Plus) *Drug Kit (EMT---A/I/PM) (1) ECG Mon/Defib/Cardio/Pac (1)Electrodes, Adult & Peds (2 ea)Defib Electrodes, A&P (2 ea) Pace Electrodes, A&P (2 ea) Sterile Needles, Syringes, IV Solutions/Tubing & IV Start Kits as determined by OMDPediatric Assessment Guide (1)Advanced Airway (EMT-E/A/I/P): *Supra-glottic Airway (1)Complete ETT Kit (1)Dressing / Supplies: *Durable First Aid KitTrauma Dressings (8x10) (4)Sterile 4x4's (24)Occlusive Dressings (3x8) (4)Assorted Roller Gauze (12)Cravats (10)Tape 1" and 2" (4 rolls)Trauma Scissors (1)Emesis Basins (2)NS for Irrigation (4 L)Oral Glucose (2)Alcohol Preps (12)Obstetrical Kit (2) containing: *Pair of sterile surgical gloves (2)Scissors or other cutting inst (1)Umbilical cord ties (4)Sanitary pads (1)Cloth / Disposable hand towels (2)Soft tip bulb syringeSplinting: *Rigid Collars, SA, MA, LA & Peds (3ea) OR Adjustable (3)Traction splint w/ ankle hitch adult and pediatric (1 ea)Padded board splint upper ext. (2)Padded board splint lower ext. (2)Backboard (2)Short spine board (1)Peds immobilization device (1)Cervical immobilization device set (2)PPE: *Waterless Antiseptic Hand Wash (1)Exam Gloves -10 pr/ea sizeDisposable Gowns (4)Face---shield/Eyewear (4)Infectious Waste Bags (4)Name *FirstLastSignature *Clear SignatureWebsiteSubmit