Equipment Log Form |

Date

Time*

: HH

MM

Unit is:*

Crew #1*

First Last

Crew #2

First Last

VST Completing Form*

Call Sign*

Fender Number*

Gas Card Present*

Present - Correct Fender
Not Present
Spare Gas Card

Fuel Level

Full
3/4
1/2
1/4

Pick the closest fuel level at the start of your shift.

Controlled Substance Box Number*

Please enter a number from 01 to 80.

List

Morphine Level	Versed Level

King Vision Present*

Yes
No

Rig Phone Number*

Sets of Keys*

Gurney Batteries Issued*

Monitor Batteries Issued*

Two
Three

Handheld Radio 1*

Lapel Mic Present Radio 1*

Yes
No

If not present for NEW radios contact supervisor ASAP

Handheld Radio 2*

Lapel Mic Present Radio 2*

Yes
No

If not present for NEW radios contact supervisor ASAP

iPad Issued*

Alpha Pager 1*

Alpha Pager 2

91 Pager 1*

91 Pager 2

Thermometer Number

Similar to other agencies around the County we will be recording temperatures at the beginning and end of shifts for all employees. This is a recommendation from the Public Health department and County EMS. You must report to the supervisor if you have a temperature above 100.4F. Thank you for your support as we try to slow the spread of COVID-19 and keep you and your fellow employees healthy and safe.

Temperature Crew Member 1*

Temperature Crew Member 2*

Enter any additional temperatures

Trainees, Interns, Ridealongs, etc.

Detail any Discrepancies

Acknowledgement*

By marking this box I acknowledge that the equipment recorded was present and accounted for at time of crew exchange. I will notify the supervisor immediately if any equipment was noted as missing.

Acknowledgement*

By marking this box I acknowledge that the equipment listed was issued to my unit.

Crew Member Receiving Equipment

First Last

To ensure that all PCRs have been completed download a trip reconciliation form from ImageTrend Elite Bridge and upload the results to this form. All PCRs (transports and cancellations) must be completed before the end of your shift.

Trip Reconciliation Upload

Upload your completed trip reconciliation obtained from ImageTrend Elite Bridge Report Writer. This will ensure that all PCRs have been posted and completed.

End of Shift

Check each box to ensure that all items have been accounted for according to company end of shift procedures:

Controlled Substances
Portable Radios
Ambulance Cell Phone
Alpha-Numeric Pagers
Frequency 91 Pagers
PCR Tablet
Ambulance Keys

Your Email for Receipt (Not Required)