Equipment Log Form -

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Date

Time*

:

Unit is:*

Logging On
Logging Off
Performing Rig Exchange
Satellite Crew Exchange (Start of Shift)
Satellite Crew Logoff

Crew #1*

First Last

P #*

First

Crew #2*

First Last

E #*

First

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

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.

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.

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Trip Reconciliation Upload

Accepted file types: pdf, Max. file size: 2 MB.

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

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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)

Number

Post Title