MONROE COUNTY EMS

EMERGENCY MEDICAL RESPONDER AGENCY INSPECTION

FORM
DATE: PASS / FAIL
AGENCY:
UNIT: VECHICLE (make/model):
Bandage/Dressing Equipment Suction Unit/Supplies
Misc. Items
S!e"#le $%$ D"e&&#'(& ))*a!!e"+ Po,e"ed S-.!#o' ))/
*la'ke!
))0 S!e"#le A*D Pad& C1a"(ed ! / " F-'.!#o'& ! / " ))/ *o%
D#&2o&a3le Glo4e&
))$ Rolle" Ga-5e $ o" 67 ))0 S-.!#o' T-3#'(/R#(#d T#2& ))$
D#&2o&a3le Fa.e Ma&k
))0 Rolle" Ga-5e 87 Air#a$ Management ))$
P"o!e.!#4e E+e,ea"
))/ Ta2e Roll ))/ Ad-l! *VM ))A'!#3a.!e"#al
9#2e&/Sol-!#o'
))/ O..l-&#4e D"e&&#'( ))/ Ped# *VM ))*#o:1a5a"d *a(&
))/ *-"' S1ee! ))/ I';a'! *VM Automated
E%ternal De&'.
))$ T"#a'(-la" *a'da(e& ))/ O"al A#",a+ Se! (< &#5e&) ))0 Se!& o; Pad&
))/ *a'da(e S1ea"& ))/ Na&al A#",a+ Se! (< &#5e&) ))S2a"e
*a!!e"+
Immo'ili(ation Equipment ))0 Na&al Ca''-la& ))P"e2 Ra5o"
))/ Se! *oa"d S2l#'!& ))0 NR* Ad-l! C1a"(ed ! / "
F-'.!#o'& ! / "
))$ R#(#d C= Colla"& ))/ NR* Ped#
P) Assessment Equip. ))/ D &5 O0 !a'k ,#!1 "e(-la!o" psi
))Ad-l! *P C-> ))/ S2a"e D C+l#'de" *ptional
Equipment
))S!e!1o&.o2e ))Lo'( S2#'e *oa"d
))Fla&1l#(1! ))O* ?#!
))P+*)*,*L MA"UAL
MONROE COUNTY EMS
EMERGENCY MEDICAL RESPONDER AGENCY INSPECTION
FORM
Comme'!&:
C1e.ked *+:
A(e'.+ Re2: