Unit Inspection Form
In conjunction with the Station Chore Chart
Date Time
Supervisor
Adam
Cariota
Kirkdorffer
Pagel
Parks
Puerto
Roberts
Tuttoilmondo
Wogan
Shift
A
B
C
D
Other/Event
Day of Week
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Medic Call Sign
91
910
92
920
93
930
94
940
95
950
96
97
980
990
Other/Event
Shop number
In-Charge
Attendant
Third
Security (cab and patient compartment locked and secured)
O2 levels (>500 cylinder/>5,000 liquid)
Fuel level (above half a tank)
Medication (select random medication)
Disposable supply (select random supply)
Cab (Clean and decluttered)
Comments
Exterior (Clean/Washed)
Comments
Patient compartment clean (Floors, trash, action area)
Comments
Stat Pack (Par levels/Secured to stretcher)
Comments
Monitor (Secured/Batteries charged)
Comments
Day specific chores (Select the chores that correspond with the wall chart.)
Comments
Upload Photos
Browse Files
Cancel
of
Overall Score (0-11)
Note to crew
In-Charge Email
example@example.com
Attendant Email
example@example.com
Third Email
example@example.com
Submit
Should be Empty: