EQC2 - CFR KIT (Group & individual) Weekly Check

1

DateDate of Check

2

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EandCFRChecks

3

Date* This field is required.Date of Check

4

Your name* This field is required.

First Name

Last Name

5

Region* This field is required.

6

Your PIN* This field is required.

7

PINIgnore duplicate

8

Call sign prefix* This field is required.

FR

ER

SR

CR

9

Call Sign associated with pager* This field is required.Where issued with pager/ Airwave device

Ignore leading zero

10

Group Name* This field is required.

11

Team (NWAS) phone numberIf applicable

i.e if phone is provided for the team by NWAS

12

Your E-mail* This field is required.

13

AED Present & rescue ready* This field is required.

Yes

No

14

AED Serial* This field is required.

15

Pads Expiry* This field is required.

Assume 1st of month

16

Pocket mask present* This field is required.

Yes

No

17

Medical sundries present (including ambulance dressings etc)* This field is required.

Yes

No

18

O2 Cylinder present - (minimum 1/3 full)* This field is required.

Yes

No

19

O2 Batch no:* This field is required.

20

O2 Expiry* This field is required.

Date

21

Non-rebreather (100%) Oxygen mask present* This field is required.

yes

no

22

Simple (60%) Oxygen mask present* This field is required.

yes

no

23

Pulse oximeter present* This field is required.

Yes

No

24

Suction device present* This field is required.

Yes

No

25

Torch present* This field is required.

Yes

No

26

NWAS Mobile phone present* This field is required.Where applicable

Yes

No

Not issued

27

Thermometer* This field is required.

YESNO

28

BP Device Present* This field is required.

YESNO

29

Airwave device present* This field is required.

Yes

No

Not applicable

30

I have checked the expiry date on all relevant items and all are within date.* This field is required.

yes

no

31

Any relevant comments (optional)

32

Comment on out of date stock

33

Do you require a copy of this to be sent to your team leader?* This field is required.

Yes

No

34

Earliest expiry date of a piece of equipment this relates to all consumable pieces of equipment (NON MANDATORY)

Date

35

Your team leader's E-mail

36

Timer* This field is required.