Read Emergency Crash Cart Check Sheet draft 4 10-30-01.PDF text version

Emergency Crash Cart Check Sheet

Draft #4 10/30/01

Unit: ___________________


Correlate with Checklist Pediatric Kit Complete/Lock# Adult Cart Complete/Lock#


(H = Dr. Heart, T = Training) Pediatric Kit Complete/Lock # Adult Cart Complete/Lock#

Adult Daily Check

Day of the Month



Checklists Daily Check Crash Cart Cart Locked Med Tray Sealed O2 Cylinder >500psi (O2 wrench) Backboard Sharps Container Defib Plugged into wall Suction Set-up Functional Electrode Cream Emergency Med. Info Sheet CPR Resuscitation Forms Lead Patches Defib Load Test Plugged Defib Load Test Unplugged External Pacer Functioning Pacerpads if applicable Pacercable if applicable Monthly Check Laryngoscope Functioning Med. Drawer Exp. < 30 Days Trays and Supplies Checked Manual Blood Pressure Cuff (Adult) Pediatric Kit Daily Check Kit Locked (Daily) Laryngoscope Functioning (Monthly) Unit Specific: Reason Codes: Dr Heart: H Training: T Comments:

1 am pm 2 am pm 3 am pm 4 am pm 5 am pm 6 am pm 7 am pm 8 am pm 9 am pm 10 am pm 11 am pm 12 am pm 13 am pm 14 am pm 15 am pm 16 am pm 17 am pm 18 am pm 19 am pm 20 am pm 21 am pm 22 am pm 23 am pm 24 am pm 25 am pm 26 am pm 27 am pm 28 am pm 29 am pm 30 am pm 31 am pm Emergency Crash Cart Check Sheet.xls 9/01


Month/Year _____________ Unit Mgr. Sig. ____________ Closed: pm - Yes No weekends - Yes No

Adult Monthly Check




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