HMG Ambulance Daily Checklist

Hospital *

Ambulance No*

Date*

Shift

Type

Level

Mileage (KM)

Outgoing Medic Name

Incoming Medic Name

Medic Badge No

Starting UpExternal Body CleanDriver A/C WorkingFrontal LightsTiers' Air & Condition & SpareWindshield WiperVehicle BrakeWarning LightSirenRadiator WaterBatteryMirrorsFuel level is > 3/4

Notes

Photos are automatically compressed (WebP, max ~250 KB, under ~1600 px) before upload, to save storage while keeping enough detail.

Front

Click to capture / upload

Back

Click to capture / upload

Right Side

Click to capture / upload

Left Side

Click to capture / upload

Inside 1

Click to capture / upload

Inside 2

Click to capture / upload

Camera is workingHead Set & MicrophoneRadioLap topInternet NetworkVIDA Access

DecontaminatedClean & TidySharp Container > 1/3 emptyGarbage is emptyCabinet attached to PlugA/C WorkingCompartment Lights Working

Main Oxygen > 700 Psi.Portable Oxygen > 1000 Psi.Oxygen RegulatorScope BoardTriage Tags 50Installed Suction with BagsPortable SuctionClip Board & ReportTissue PaperHand Sanitizer BottleSanitizer Wipes BoxMinuten Spray BottleDisposable Gloves S,M,L,XL

Clean RefrigeratorRefrig. Temperature ListFire Extinguisher2 Blanket2 Bed sheetPillowStryker with 2 StrapsBattery attached to StrykerExtra Stryker Battery on ChargerStair Chair with 2 strapsFolding Stretcher with 5 Straps

Bag is AvailableBag is Sealed

Seal No

Defibrillator Available2 BatteryBP Cuff (Adult & Pedia)SpO2 Sensor (Adult & Pedia)Extra Roll of ECG PaperPads (Adult & Pedia)ECG Electrodes (Adult & Pedia)12 Leads ECG CablePediatric PaddlesRazor

Manual BP Cuff + Stethoscope (Adult & Pedia)Sterile Water Bottle 1000ml (irrigation)

Sharp containerSam Splint

IV Cannula (18,20,22,24)Tegaderm & Plaster & TourniquetSyringes (1,3,5,10,20,50 ML)IV Set Infusion & Pressure IV fluid BagThree Way stopcockAlcohol SwabBVM (Adult & Pedia & Neonate)ETT cuffed & Uncuffed (3 → 9)LMA (1, 1.5, 2, 2.5, 3, 4, 5)King Tube (1,2,3,4,5)Soft Suction Tube (6,8,10,12,14,16)10 ml SyringeET Secure & KY JellyCO2 Detector (Adult & Pedia)Stylet & Bougi (Adult & Pedia)Magill Forceps (Adult & Pedia)14 G Needle (Decompression)

Laryngoscope Handle Thick & ThinLaryngoscope Blade Mac & Mill (0,1,2,3,4)Spare Battery

Back Board with 5 StrapsSpider Harness (Optional)Head Immobilizer (Adult & Pedia)C-Collar (Adult & Pedia)Splint & SAM splintExtra StrapsFull Portable Oxygen Size D

Nasal Cannula (Adult & Pedia)Nebulizer Kit with Mask (Adult & Pedia)Nonrebreather Mask (Adult & Pedia)Simple Mask (Adult & Pedia)

Suction TubingRigid Suction TubeSoft Suction Tube (6,8,10,12,14,16)Stethoscope (Adult & Pedia)

Surgical MaskYellow Gown & Surgical GownHead Cover & Shoes CoverN95 Mask S,M,LGogglesFace ShieldBiohazard Bag

IV Cannula (18,20,22,24)Syringe (1,3,5,10,20,50)IV Infusion Set & Three Way StopcockAlcohol SwapTourniquetTegaderm & BlasterPressure IV fluid BagGlucometer Kit & Tympanic ThermometerUrinal

Crepe Bandage (15*4.5 / 10*4.5 cm)Slinky Bandage (12*4 / 10*4 / 8*4 cm)Gauze (2*2 & 4*4 inch)Sterile GauzeSterile Gloves 6,7,8Opsite (15.5*8.5 / 9.5*8.5 cm)Primapore (25*10 / 15*8 / 8.3*6 cm)Multi Trauma Dressing S, M, LTriangular BandageIce Pack & Eye Pads & Vomiting BagUnder Pads (Chux)Bottle Sterile H2O for IrrigationBurn PadsScissorOB Kit (Baby Blanket, Umbilical Cord Clamps, Scissors/Scalpel, Bulb Syringe, Placenta Basin, Plastic Pad)

OPA (00,1,2,3,4) & NPA (6,7,8) & KY JellyGlucometer & Strips & LancetsSterile Gloves (6,7,8)

Crepe Bandage (15*4.5 / 10*4.5 cm)Gauze (2*2, 4*4)Bandage ScissorTriangle Bandage

Outgoing Team Leader

Outgoing Team Leader Badge No

Ongoing Team Leader

Ongoing Team Leader Badge No

Submitted by (your name)

Shift Information

I. External Body & Mechanical — Vehicle Readiness

Ambulance Photos (6 required: front, back, sides, inside)

II. Medical & Cabinet Readiness — Communication & Technology

Patient Cabinet

Fix Assets — Column 1

Fix Assets — Column 2

Medication Bag

Defibrillator

III. ALS Bag — Right Side Pouch

ALS Bag — Left Side Pouch

ALS Bag — Main Compartment

ALS Bag — Intubation Kit (A&P)

Under Bench

Compartment A — Oxygen Masks

Compartment B — Suction & Stethoscope

Compartment C — PPE

Compartment D — IV & Glucometer

Compartment E — Bandages & Trauma

Front Pouch

Rear Pouch

Team Leader Signatures