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Vehicle Daily Inspection
West Belfast Division
18
Questions
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1
Inspection Date:
*
This field is required.
-
Date
Day
Month
Year
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
08
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
Hour
00
10
20
30
40
50
00
00
10
20
30
40
50
Minutes
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2
Vehicle Callsign:
*
This field is required.
Please ensure you have the correct license category to drive this vehicle.
PA030
PA031
PA032
PA033
PA034
PA035
PA036
PA037
PA038
PA039
PA073
PA075
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3
Starting Milage:
*
This field is required.
As seen on the odometer
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4
Duty Type
*
This field is required.
Please Select
Event Cover
NiAS EOC Support
NHS Transfers (Inc. NEOC Support)
Community Service (Show & Tell / Charitable Work)
Training / Maintenace
Major Incident Deployment
Event Cover
Please Select
Event Cover
NiAS EOC Support
NHS Transfers (Inc. NEOC Support)
Community Service (Show & Tell / Charitable Work)
Training / Maintenace
Major Incident Deployment
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5
Drivers Name
*
This field is required.
If name not listed or visiting member then select option at bottom and manuall fill in your name. If your name is incorrectly spelled please alert Diarmuid.MacMahon@sjani.org
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6
Drivers Full Name - Manual Entry
*
This field is required.
Please ensure proper spelling as this will create a ticket to add your name to the list above.
First Name
Last Name
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7
Attendant Name
*
This field is required.
If name not listed or visiting member then select option at bottom and manuall fill in your name. If your name is incorrectly spelled please alert Diarmuid.MacMahon@sjani.org
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8
Attendant Full Name - Manual Entry
*
This field is required.
Please ensure proper spelling as this will create a ticket to add your name to the list above.
First Name
Last Name
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9
Additional Person Name (1)
If name not listed or visiting member then select option at bottom and manuall fill in your name. If your name is incorrectly spelled please alert Diarmuid.MacMahon@sjani.org
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10
Additional Person Full Name (1) - Manual Entry
*
This field is required.
Please ensure proper spelling as this will create a ticket to add your name to the list above.
First Name
Last Name
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11
Additional Person Name (2)
If name not listed or visiting member then select option at bottom and manuall fill in your name. If your name is incorrectly spelled please alert Diarmuid.MacMahon@sjani.org
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12
Additional Person Full Name (2) - Manual Entry
*
This field is required.
Please ensure proper spelling as this will create a ticket to add your name to the list above.
First Name
Last Name
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13
Vehicle Driver Checks:
*
This field is required.
Are the following in good working condition? Fully tested?
Satisfactory
Faulty
Satisfactory
Faulty
Satisfactory
Faulty
Satisfactory
Faulty
Satisfactory
Faulty
Satisfactory
Faulty
Satisfactory
Faulty
Blue Lights & Siren
Head lights/Break Lights/Reversing Lights
Hazard Lights & Indicators
Road Horn/Reversing Horn
Oil/Coolant/Screen wash/Fuel levels
Tyres (Condition & Pressure)
Ramp/Doors/Seatbelts
Blue Lights & Siren
Head lights/Break Lights/Reversing Lights
Hazard Lights & Indicators
Road Horn/Reversing Horn
Oil/Coolant/Screen wash/Fuel levels
Tyres (Condition & Pressure)
Ramp/Doors/Seatbelts
Satisfactory
Faulty
Satisfactory
Faulty
Satisfactory
Faulty
Satisfactory
Faulty
Satisfactory
Faulty
Satisfactory
Faulty
Satisfactory
Faulty
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14
Red-List Checks:
*
This field is required.
MUST BE CHECKED BEFORE LEAVING STATION FOR ANY REASON. Are the following present & in good working order?
Satisfactory
Required Restock
Satisfactory
Required Restock
Satisfactory
Required Restock
Satisfactory
Required Restock
Satisfactory
Required Restock
Satisfactory
Required Restock
Satisfactory
Required Restock
Zoll X-Series (Inc. All Accessories)
Zoll AED Pro (Inc. All Accessories)
Response Bag
Major Trauma Kit
Suction Unit
Oxygen (Portable + Vehicle)
Entonox
Zoll X-Series (Inc. All Accessories)
Zoll AED Pro (Inc. All Accessories)
Response Bag
Major Trauma Kit
Suction Unit
Oxygen (Portable + Vehicle)
Entonox
Satisfactory
Required Restock
Satisfactory
Required Restock
Satisfactory
Required Restock
Satisfactory
Required Restock
Satisfactory
Required Restock
Satisfactory
Required Restock
Satisfactory
Required Restock
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15
Green-List Checks
*
This field is required.
MUST BE CHECKED AS SOON AS FESIBLE. Are the following present & in good working order?
Satisfactory
Required Restocked
Satisfactory
Required Restocked
Satisfactory
Required Restocked
Satisfactory
Required Restocked
Satisfactory
Required Restocked
Satisfactory
Required Restocked
Satisfactory
Required Restocked
Satisfactory
Required Restocked
Observations Kit
Wound Care (Saline/Gauze/Bandages)
Fracture Management (Vac Splints/Box Splints)
Immobilisation Kit (Scoop/Combi/VacMat/Head blocks/Collars)
Maternity/Paediatric Kit
Airway & O2 Delivery kit
Stretcher Functions & Linen
Crew PPE
Observations Kit
Wound Care (Saline/Gauze/Bandages)
Fracture Management (Vac Splints/Box Splints)
Immobilisation Kit (Scoop/Combi/VacMat/Head blocks/Collars)
Maternity/Paediatric Kit
Airway & O2 Delivery kit
Stretcher Functions & Linen
Crew PPE
Satisfactory
Required Restocked
Satisfactory
Required Restocked
Satisfactory
Required Restocked
Satisfactory
Required Restocked
Satisfactory
Required Restocked
Satisfactory
Required Restocked
Satisfactory
Required Restocked
Satisfactory
Required Restocked
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16
Is There Anything to Report?
*
This field is required.
Please use this space to report anything concerning / abnormal / missing / out-of-date / unservicable etc.
YES
NO
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17
Optional: Take Photo:
Upload a photo as evidence
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18
Details:
*
This field is required.
Include as much detail as possible.
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Should be Empty:
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