Template Information
This form is used by all samaritan crew members to perform daily shift change inspections.
Category: general
Template Questions
- General Vehicle Condition
- If damage is noted please take a photo of the damaged area?
- If there is damage noted in the cab of the truck please take a picture.
- If damage is noted in the patient compartment please take a picture.
- Fuel and general engine fluids check
- Emergency Alert Systems and General Lights
- Enter additional detail as necessary for any negative findings above?
- Stretcher/Response bags/Monitor
- Monitor passed user test?
- Narrative for Stretcher/Response bags/Monitor section. (Only required if you marked a no answer)
- Patient Compartment
- Safety Equipment
- Adult Nasal Cannula Count
- Oropharyngeal Airway, 1 each size