MUNICIPAL DISASTER RISK AND MANAGEMENT OFFICE

MDRRMO
JUBAN , SORSOGON
MAINTENANCE / INVENTORY FORM 2019 V1

Name of Vehicle: Rescue Vehicle – R1 Date:

Type: Truck Single Cab, Closed Van Time:
Brand: Hino Odometer:
Plate No. ` Fuel:
Registration Due date:
A. BODY CONDITION (put (x) if damaged/dented)

DASH BOARD INDICATOR LIGHT (Pls Check if visible)

Indicate the Condition below using the following:

( / ) OK ( X ) Defective ( 0 ) Out of Service (N/A) Not Applicable
B. HEAD / ENGINE COMPARTMENT Condition Repaired Remarks
B1 Engine Oil
B2 Radiator Water / Coolant
B3 Brake Fluid
B4 Power Steering Fluid
B5 Clutch Fluid
B6 Inspect all belts
B7 Inspect all hoses
B8 Inspect / Check for Leaks including under chassis
B9 Check Washer
B10 Check Wiper
B11 Check Battery Water Level
B12 Start Engine
B13 Step on Gas Pedal
B14 Check Breaks
B15 Check Clutch and Shift Gear
C. BODY Condition Repaired Remarks
C1 Head Lights
C2 Signal Lights
C3 Break Lights
C4 Hazard Lights
C5 Siren/ Strobe Lights Front
C6 Check Siren Operation, Modes, Horn/ Siren
C7 Check Windows
C8 Check Side/Center Mirror
C9 Check Door Lock Cab and Back
C10 Tire Pressure
C11 Reserve Tire
C12 Hydraulic Jack
C13 Tiring Kit Wrench
D. INTERIOR Condition Repaired Remarks
D1 Aircon (Cab)
D2 Light (Back)
 D3 Aircon (Cab)
D4 Lights (Back)
E. RESCUE / EXTICATION EQUIPMENT Condition Repaired Remarks
E1 Spine Board
E2 Scoop Spine Board
E3 Stretcher
E4 KED / Short Board
E5 C collar
E6 Triangular Bandage
E7 Elastic Bandage
E8 Splints
E9 Trauma Bag / First Aid Kit
E10 Gauzes
E11 Bandages
E12 Cherry (Cotton Soaked with Prov. Iodine)
E13 Alcohol
E14 Pulse Oximeter
E15 Flash Light
E16 Oxygen Level ____________________
E17 Bag Valve Mask Adult
E18 Bag Valve Mask Infant
E19 Fire Extinguisher
E20 Crowbar
E21 Bolt cutter
E22 Knife / Bolo
F. PPEs Condition Repaired Remarks
F1 Gloves
F2 Goggles
F3 Mask
F4 Reflectorize Vib
G. REMARKS / RECOMMENDATION

Note: Please close all windows and lock all doors after inspection.

INSPECTED BY: ASSISTED BY:

___________________ __________________
INSPECTOR In-charge Assistant Inspector

APPROVED BY:

DENNIS DESPABILADERAS
LDRRMO I – Administration Officer

Noted by:

ARVEE TEE LODRONIO

LDRRMO II / MDRRMO
 MUNICIPAL DISASTER RISK AND MANAGEMENT OFFICE
MDRRMO
JUBAN , SORSOGON
MAINTENANCE / INVENTORY FORM 2019 V1
Name of Vehicle: MDRRMO Pickup Date:
Type: Double Cab Pickup Time:
Brand/Model: Toyota / Hilux Odometer:
Plate No. Fuel:
Registration Due date:
A. BODY CONDITION (put (x) if damaged/dented)

DASH BOARD INDICATOR LIGHT (Pls Check if visible)

Indicate the Condition below using the following:

( / ) OK ( X ) Defective ( 0 ) Out of Service (N/A) Not Applicable
B. HEAD / ENGINE COMPARTMENT Condition Repaired Remarks
B1 Engine Oil
B2 Radiator Water / Coolant
B3 Brake Fluid
B4 Power Steering Fluid
B5 Clutch Fluid
B6 Inspect all belts
B7 Inspect all hoses
B8 Inspect / Check for Leaks
B9 Check Washer
B10 Check Wiper
B11 Check Battery Water Level
B12 Start Engine
B13 Step on Gas Pedal
B14 Check Breaks
B15 Check Clutch and Shift Gear
C. BODY Condition Repaired Remarks
C1 Head Lights
C2 Signal Lights
C3 Break Lights
C4 Hazard Lights
C5 Siren/ Strobe Lights Front
C6 Check Siren Operation, Modes, Horn/ Siren
C7 Check Power Windows
C8 Check Side Mirror Motor
C9 Check Door Lock Cab and Back
C10 Tire Pressure
C11 Reserve Tire
C12 Hydraulic Jack
C13 Tiring Kit Wrench
D. INTERIOR Condition Repaired Remarks
D1 Aircon / Fan
D2 Light
D3 Check Stereo
E. FIRST AID KIT Condition Repaired Remarks
E1 Triangular Bandage
E7 Splints
E9 Gauzes
 E10 Bandages
E11 Cherry (Cotton Soaked with Prov. Iodine)
E12 Alcohol
E13 Pulse Oximeter
E14 Flash Light
E18 Fire Extinguisher
F. PPEs Condition Repaired Remarks
F1 Gloves
F2 Goggles
F3 Mask
F4 Reflectorize Vib
G. REMARKS / RECOMMENDATION

Note: Please close all windows and lock all doors after inspection.

INSPECTED BY: ASSISTED BY:

___________________ __________________ __________________

INSPECTOR In-charge Assistant Inspector Assistant Inspector

APPROVED BY:

DENNIS DESPABILADERAS
LDRRMO I –Administration Officer

Noted by:

ARVEE TEE LODRONIO

LDRRMO II / MDRRMO
 MUNICIPAL DISASTER RISK AND MANAGEMENT OFFICE
MDRRMO
JUBAN , SORSOGON
MAINTENANCE / INVENTORY FORM 2021 V1
Name of Vehicle: Rescue Vehicle – R2 Date:
Type: Closed Van Time:
Brand: Toyota Odometer:
Plate No. ` Fuel:
Registration Due date:
A. BODY CONDITION (put (x) if damaged/dented)

DASH BOARD INDICATOR LIGHT (Pls Check if visible)

Indicate the Condition below using the following:

( / ) OK ( X ) Defective ( 0 ) Out of Service (N/A) Not Applicable
B. HEAD / ENGINE COMPARTMENT Condition Repaired Remarks
B1 Engine Oil
B2 Radiator Water / Coolant
B3 Brake Fluid
B4 Power Steering Fluid
B5 Clutch Fluid
B6 Inspect all belts
B7 Inspect all hoses
B8 Inspect / Check for Leaks including under chassis
B9 Check Washer
B10 Check Wiper
B11 Check Battery Water Level
B12 Start Engine
B13 Step on Gas Pedal
B14 Check Breaks
B15 Shift Gear
C. BODY Condition Repaired Remarks
C1 Head Lights
C2 Signal Lights
C3 Break Lights
C4 Hazard Lights
C5 Siren/ Strobe Lights Front
C6 Check Siren Operation, Modes, Horn/ Siren
C7 Check Windows
C8 Check Side/Center Mirror
C9 Check Door Lock Cab and Back
C10 Tire Pressure
C11 Reserve Tire
C12 Hydraulic Jack
C13 Tiring Kit Wrench
D. INTERIOR Condition Repaired Remarks
D1 Aircon (Cab)
D2 Light (Back)
D3 Aircon (Cab)
D4 Lights (Back)
E. RESCUE / EXTICATION EQUIPMENT Condition Repaired Remarks
E1 Spine Board
E2 Scoop Spine Board
 E3 Stretcher
E4 KED / Short Board
E5 C collar
E6 Triangular Bandage
E7 Splints
E8 Trauma Bag / First Aid Kit
E9 Gauzes
E10 Bandages
E11 Cherry (Cotton Soaked with Prov. Iodine)
E12 Alcohol
E13 Pulse Oximeter
E14 Flash Light
E15 Oxygen Level ____________________
E16 Bag Valve Mask Adult
E17 Bag Valve Mask Infant
E18 Fire Extinguisher
E19 Crowbar
E20 Bolt cutter
E21 Knife / Bolo
F. PPEs Unit Number Remarks
F1 Gloves
F2 Goggles
F3 Mask
F4 Cover All
F5 Reflectorize Vib
G. REMARKS / RECOMMENDATION

Note: Please close all windows and lock all doors after inspection.

INSPECTED BY: ASSISTED BY:

___________________ __________________
INSPECTOR In-charge Assistant Inspector

APPROVED BY:

DENNIS DESPABILADERAS
LDRRMO I – Administration Officer

Noted by:

ARVEE TEE LODRONIO

LDRRMO II / MDRRMO