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MOHAWK VALLEY AMBULANCE CORPS

Daily ALS Rig Check

Date(Required)

Assigned Vehicle Number(Required)

Crew Member 1(Required)

Crew Member 2(Required)

Is there a ride along? (Student or new hire)(Required)

Yes

No

If yes, who is the ride along or student?

*ENSURE YOUR VEHICLE HAS FULFILLED ALL BOXES BELOW*

ALS Check:

Monitor Checked/Tested/Stocked

Monitor Number

Cabinet IV Supplies Checked and Stocked

Cabinet Airway Checked and Stocked

ALS Bag-Medication Pouch Checked and Stocked

ALS BAG-IV Supplies Pouch Checked and Stocked

ALS BAG-Airway Pouch Checked and Stocked

ALS BAG-Medication Box Checked and Stocked

Narcotics Safe Checked (Check Safe Battery Indicator)

Narcotics Box Seal Number(Required)

Narcotics Box Number

Narcotics Expiration Date(Required)

Month

Day

Year

Were there any items missing from your ALS Check?

Go to Employee Page

Go to Reports Page

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