APPENDIX
MAINTENANCE & INVENTORY
CONTROL FORMS
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HCFR Apparatus Work Order Request Form
HCFR Apparatus Work Order Request Form –
Mechanic Generated
HCFR Property Damage/Loss Notification Form
HCFR Equipment Repair Tag
HCFR SCBAWeekly Inspection Log
HCFR SCBAAfter Each Use Inspection Log
Pump Service Test Log
Hose Test Log
Apparatus Mileages/Hours Report
HCFR Ambulance Inventory Check Sheet
HCFR Career Engine Check-Off Sheet
HCFR Career Ladder/Tower Check-Off Sheet
HCFR Career Check –Off Sheet for Utility Vehicles,
Brush Units, Mobile Air Units and Light Duty Squads
HCFR Ambulance Check-Off Sheet
HCFR Volunteer Engine Check-Off Sheet
HCFR Volunteer Ladder/Tower Check-Off Sheet
HCFR Volunteer Check –Off Sheet for Utility Vehicles,
Brush Units, Mobile Air Units and Light Duty Squads
HORRY COUNTY
FIRE/RESCUE
APPARATUS WORK ORDER REQUEST
FAX TO: 248-1695
Asset No:____________
Status of unit
(Check One)
Running As:____________
Out of Service: _____________
Time: ________ Date: ________
Date:____________
In Service: ___________
Unit Placed Out of Service in Equipment Inventory by Battalion Chief/Medical Officer:
 YES
 NO
Battalion Chief/Medical Officer Name:
Mileage:______________
Hours:______________
________________________
Station:______________
State Problem(s) in Detail:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Reported By:_____________________________________
Type Full Name
Administration Only
Work order #: _____________________________________
Date Work order Entered: __________________________
Entered By: _______________________________________
Phone No.:_______________
HORRY COUNTY
FIRE/RESCUE
APPARATUS WORK ORDER REQUEST
Mechanic Generated
Asset No:____________
Status of unit
(Check One)
Mileage:______________
Running As:____________
Out of Service: _____________
Time: ________ Date: ________
Hours:______________
Date:____________
In Service: ___________
Station:______________
State Problem(s) in Detail:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Mechanic
Activity
Hours
Mechanic
Activity
Hours
__________
__________
_____
__________
__________
_____
__________
__________
_____
__________
__________
_____
__________
__________
_____
__________
__________
_____
__________
__________
_____
__________
__________
_____
Mechanic:____________________________________
Print Full Name
Mechanic No.:_______________
HORRY COUNTY FIRE/RESCUE
Property Damage/Loss Notification Form
1. Type of Report – Circle One
a. Missing Equipment
b. Damaged Equipment
Equipment
c. Stolen
(Attach Police
Report)
2. Reporting Employee Information
Last Name
First Name
Position Title
Volunteer
Station
MI
Status (Circle One):
Shift
Career
Supervisor’s Name
3. Responsible Employee Information (If unknown, explain in detail in Comment Section)
Last Name
First Name
Position Title
Volunteer
Station
MI
Status (Circle One):
Shift
Career
Supervisor’s Name
4. Damaged/Lost Equipment Information
Date/Time of Loss/Damaged
of-Service
Status Circle One: In-Service Out-
Incident Location
Date Loss/Damage Discovered
Description of Equipment
Applicable)
Briefly Describe Damage(s)
Date/Time Battalion Chief Notified (If Applicable)
Time Loss/Damage Discovered
Serial Number (If
4. Comment Section: Description of How the Property Was Lost/Damaged (Print or Type and
Attach Additional Statements if Needed).
5. Signatures
Reporting Employee Signature
Date
Reporting Employee Supervisor Signature
Date
Battalion Chief Signature (If Applicable)
Date
The Property Damage/Loss Notification Form must be completed for all lost or damaged
property and must be submitted to the Assistant Chief of Support Services within twentyfour (24) hours of the incident.
HORRY COUNTY FIRE RESCUE
Weekly SCBA Inspection Log
Date Inpected: _________________ Inspected By: _____________________________________________
Station: ______________
SCBA Apparatus Number
Shift: ____________
Manufacuture
Date
Apparatus/Fleet #: _________________________
Condition/
Cleanliness
BAD OK BAD
Regualator
Facepiece
Pass Alarm
OK
OK
OK
BAD
BAD
Comments
1
2
3
4
5
6
Cylinder Number
1
2
3
4
5
6
7
8
9
10
11
12
Manufacuture Hydro Test
Date
Date
Cylinder
Pressure
Condition/
Cleanliness
OK BAD
Comments
HORRY COUNTY FIRE RESCUE
After Each Use SCBA Inspection Log
SCBA Serial Number: __________________________________________________
Station: ________________________
Date Used
Cylinder Pressure
Shift: ______________
Cylinder
Changed
Yes
No
Facepiece
Condition
Okay
Bad
Connections
Okay
Bad
SCBA
Apparatus
Condition
Okay
Bad
Apparatus/Fleet #: _____________
Cleaned/
Sanitized
Okay
Bad
Inspected By
Date Inspected
HORRY COUNTY FIRE/RESCUE
Pump Service Test Results
Asset # __________________________ Apparatus # _______________________ Date: __________________
Test Site Location: ____________________________________________________________________________
Manufacture: ___________________________________ Serial #: ____________________________________
Make: ___________________________________________
Model: ___________________________________
Year: ______________________ Rated Capacity of Pump (GPM): ___________________________________
Pump Make: ________________________________________Pump Model: _____________________________
Suction Hose Size:____________________________
Suction Hose Length: ____________________________
Atmospheric Pressure
Air Temperature
Water Temperature
Elevation of Test Site
Lift
Required Duration (Minutes)
Pump Pressure (PSI)
Pass/Fail
Time Started
Time Ended
Vacuum Attained (@least 22 in. Hg)
Drop Inches Hg (no more than 10 in. Hg)
Lift in Feet
Tip Size
Nozzle Pressure
Engine RPM
Pump RPM (if available)
Engine Temperature
Oil Pressure
Test Discharge Gauge Reading
Apparatus Discharge Gauge Reading
Test Suction Gauge Reading
Apparatus Suction Gauge Reading
Flow (GPM)
Vacuum
Test
100% Capacity
Test
70% Capacity
Test
50% Capacity
Test
5
20
10
10
150
200
250
Overload Test
5
165 @ 100%
Capacity
HORRY COUNTY FIRE RESCUE
Hose Testing Log
STATION: _______ SPARE: YES/NO (Circle One)
HOSE ID
HOSE SIZE
DATE TESTED
APPARATUS ASSET # __________________
TYPE TEST
PASS/FAIL
PRINT NAME: __________________________________________
RANK: _____________________
SIGNATURE: ___________________________________________
DATE: _____________________
COMENTS
HORRY COUNTY FIRE RESCUE
WEEKLY MILEAGE/HOUR REPORT
Please fax to 248-1695 on Every Monday.
Station #: _________________________
APPRATUS 1:
DATE: _____________________
Asset Number:_________________
Running As: _______________________
Mileage:___________________________
HOURS: ___________________________
APPRATUS 2:
Running As: _______________________
Asset Number:_________________
Mileage:___________________________
HOURS: ___________________________
APPRATUS 3:
Running As: _______________________
Asset Number:_________________
Mileage:___________________________
HOURS: ___________________________
APPRATUS 4:
Running As: _______________________
Asset Number:_________________
Mileage:___________________________
HOURS: ___________________________
APPRATUS 5:
Running As: _______________________
Asset Number:_________________
Mileage:___________________________
HOURS: ___________________________
APPRATUS 6:
Running As: _______________________
Asset Number:_________________
Mileage:___________________________
HOURS: ___________________________
STATION PROPANE LEVEL: _________________________ (IF APPLICABLE)
Employee Name:_______________________ Signature:_______________________
(PRINT)
Revised February 7, 2008. Supercedes all other editions.
HORRY COUNTY FIRE/RESCUE
Ambulance Inventory Check Sheet
DATE
TIME
STATION
TRUCK
MILEAGE
SERVICE MILEAGE
TRUCK WASHED & CLEAN
STATION CLEAN
VHF PAGER
VHF PORTABLE
VHF MOBILE
800 MHz PORTABLE
COMPUTER W/ CASE
COMPUTER CHARGER
TOOLS
JUMPER CABLES
2 FIRE EXTINGUISHERS
3 REFLECTIVE TRIANGLES
2 SETS HEAD PROTECTION
2 PAIRS OF WORK GLOVES
ADJUSTABLE WRENCH
VICE GRIPS
PHILLIPS SCREWDRIVER
FLAT SCREWDRIVER
HACKSAW W/ 6 BLADES
PRY AX
BOLT CUTTERS
TIN SNIPS
SHOVEL
2 ROPES
2 FLASHLIGHTS
2 SAFETY VESTS
SUPPLIES
BENCH BP CUFF
THIGH CUFF
STETHOSCOPE
3 of Ea. ORAL AIRWAY
3 of Ea. NASAL AIRWAY
2 ADULT BVM
DEMAND VALVE w/ MASK
O2 HUMIDIFIER
6 NASAL CANNULAS
6 ADULT NON REBREATHERS
6 NEBULIZERS
5 TONGUE DEPRESSORS
5 BITE STICKS
LARGE 02 PSI
SMALL O2 PSI
SPARE SMALL O2
3 TONSIL TIP SUCTION CATHS
2 of Ea. SUCTION CATH 8, 10, 18
1 BOX ALCOHOL PREPS
1 BOX BETADINE PREPS
3 BOXES of 4 X 4'S
2 BOXES OF ABD PADS
1 BOX of ADAPTIC
1 BOX of BAND-AIDS
1 PAIR of SHELF SCISSORS
1 BOX of Ea. TAPE 1" & 2"
10 of Ea. KLING 2", 4" & 6"
10 TRIANGLE BANDAGES
6 HOT PACKS
6 COLD PACKS
12 STERILE WATER
4 BURN SHEETS
3 of Ea. SIZE STERILE GLOVES
OB KIT & DE LEE SUCTION
10 ISOLATION GOWNS
10 DUST MASKS
3 of Ea. NIOSH MASK
2 SETS of EYE PROTECTION
2 URINALS
5 EMESIS BASINS
2 BED PANS w/ TOILET PAPER
THERMOMETER & SHEATHS
2 PACKS of TISSUE
2 PEN LIGHTS
4 RESTRAINTS
12 SHEETS
1 BLANKET (FALL & WINTER USE)
1 BOX of Ea. SIZE EXAM GLOVE
EQUIPMENT
PORT. SUCTION W/2 BATTERIES
4 PEDI C-COLLARS
4 BABY C-COLLARS
4 NO NECK C-COLLARS
4 SHORT C-COLLARS
4 REGULAR C-COLLARS
4 TALL C-COLLARS
10 HEAD IMMOBILIZERS
4 LSB
1 SET OF HEAD BLOCKS
2 KED'S
1 PEDI IMMOBILIZER
2 SAND BAGS
3 9' STRAPS
16 QUICK CONNECT STRAPS
3 SPARE STRETCHER STRAPS
2 of Ea. FRAC PAC (ARMS & LEGS)
2 OF Ea. BOARD SPLINT 15" 36"
ADULT TRACTION SPLINT
PEDIATRIC TRACTION SPLINT
ADULT MAST
PEDIATRIC MAST
PEDIATRIC SUPPLIES
PEDIATRIC B/P CUFF
2 CHILD BVM
2 INFANT BVM
ASSORTED BVM MASKS
2 Ea. 40 & 60mm ORAL AIRWAY
2 of Ea. ET TUBE 2.5 - 5.0mm
2 PEDIATRIC STYLETS
1 Ea. IO NEEDLE 15g & 18g
3 PEDIATRIC NRB MASKS
3 PEDIATRIC NASAL CANNULAS
1 # 6 fr. SUCTION CATH.
1 BRASLOW TAPE
2 BUTTERFLY NEEDLES
2 DEXTROSE 25%
ALS SUPPLIES
10 of Ea. JELCO 22g - 14g
4 BUTTERFLY NEEDLES
20 BLUNT TIP CATHETERS
20 LEVER LOCK CANNULAS
10 OF Ea. SYRINGE 1 , 3 , 10cc
5 30cc SYRINGES
10 MICRO DROP SETS
10 MACRO DROP SETS
8 D5w
1BX TEST STRIPS
25 LANCETS
10 VENIGARDS
10 TOURNIQUETS
AIRWAY KIT
LARYNGOSCOPE HANDLE
1 Ea. ,2,3,4 MAC BLADES
1 Ea. 0,1,2,3, MIL BLADES
2 OF Ea. TUBE 5,6,7,8,9
2 ADULT STYLETS
2 TUBE HOLDERS
10 PACKS OF KY JELLY
4 TUBE HOLDERS
1 ROLL OF TAPE
MAGIL FORCEPS
2 10cc SYRINGES
2 TUBE CHECKS
2 14g LONG JELCOS
2 C CELL BATTERIES
LIFEPAK 12
5 BATTERIES
2 PACKS of ELECTRODES
2 ADULT COMBO PADS
2 PEDI COMBO PADS
1 SET of PT CABLES
1 SET of 12 LEAD CABLES
1 SET of COMBO CABLES
PULSE OX ATTACHED
JUMP KIT
1 ADULT BVM
1 of Ea. SIZE ORAL AIRWAY
1 of Ea. SIZE NASAL AIRWAY
1 ADULT NRB MASK
1 ADULT NASAL CANNULA
1 NEBULIZER
10 4 X 4'S
5 SURGI PADS
4 ROLLS of KLING
2 ROLLS of TAPE
1 BOTTLE STERILE WATER
SCISSORS
ADULT B/P CUFF
STETHOSCOPE
PEN LIGHT
1 MICRO DRIP SET
2 MACRO DRIP SETS
2 NORMAL SALINE
4 of Ea. JELCO
6 ALCOHOL PREPS
6 BETADINE PREPS
4 VENIGARDS
2 TOURNIQUETS
10 BAND-AIDS
Sm SHARPS CONTAINER
GLUCOMETER & TEST STRPS
10 LANCETS
1 LANCET PEN
4 ALBUTEROL
3 ATROPINE
1 BOTTLE BABY ASPIRIN
1 50% DEXTROSE
1 EPI 1:1,000
3 EPI 1:10,000
2 INSTANT GLUCOSE
3 100mg LIDOCAINE
2 PROCAINAMIDE
50ml BAG of D5W
2 THIAMINE
1 NITRO SPRAY
2 DEXTROSE 25%
1 GLUCAGEN
2 MAGNESIUM SULFATE
1 CALCIUM GLUCANATEGluconate
1 LABETALOL
2 of Ea. SYRINGE 1cc,3cc,10cc
10 BLUNT TIP CATHETERS
5 LEVER LOCK CANNULAS
2 ISOLATION GOWNS
2 SETS of EYE PROTECTION
2 DUST MASKS
MISC. SUPPLIES
BOTTLE of 1% HYPOCHLORITE
1 ROLL of BIOHAZARD LABELS
1 SPARE Lg SHARPS CONTAINER
1 SPARE Sm SHARPS CONTAINER
2 SPARE SUCTION CANISTERS
SPARE SUCTION LINERS
TRIAGE TAPE
CREDIT CARDS
MAP BOOK
PROTOCOLS
PAPERWORK
OIL DRY
DRUGS
1 ACTIVATED CHARCOAL
5 ADENOCARD
8 ALBUTEROL
6 ATROPINE
3 BENADRYL
2 DEXTROSE 50%
2 DOPAMINE
12 EPI 1:10,000
1 EPI 1:1,000
3 INSTANT GLUCOSE
1 IPECAC
5 LASIX
6 100mg LIDOCAINE
1 ONE GRAM LIDOCAINE
4 NARCAN
1 NITRONOX
1 NITRO SPRAY
1 PROCAINAMIDE
2 SODIUM BICARB
2 THIAMINE
2 VALIUM
4 MORPHINE
4 PHENERAN
1 GLUCAGEN
4 MAGNESIUM SULFATE
1 CALCIUM GLUCANATE
1 LABETALOL
FIRST CREW SIGN OFF
SENIOR CREW MEMBER
PRINT
SECOND CREW SIGN OFF
SENIOR CREW MEMBER
PRINT
THIRD CREW SIGN OFF
SENIOR CREW MEMBER
PRINT
SENIOR CREW SIGNATURE
SENIOR CREW SIGNATURE
SENIOR CREW SIGNATURE
2ND CREW MEMBER
PRINT
2ND CREW MEMBER
PRINT
2ND CREW MEMBER
PRINT
2ND MEMBER SIGNATURE
2ND CREW MEMBER SIGNATURE
2ND CREW MEMBER SIGNATURE
MISC. EQUIPMENT
VACU SPLINTS
JELLYFISH STING KIT
WATER CAN
SCOTT PACKS
HALAGAN BAR & AX
HORRY COUNTY FIRE/RESCUE
Engine Maintenance Check-Off Sheet
CAREER PERSONNEL
DATE: _______________________APPARATUS NUMBER:________________________
ASSET NUMBER:___________________ MILEAGE_____________________
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Daily Checks
Apparatus Appearance
Fuel Level
Battery Voltage
Start Engine
Parking Brake
Emergency Equipment
Emergency Lights
Siren (Electronic)
Siren (Mechanical)
Air Horns
Headlights & Turn Signals
Radios
Mobiles
Portables
Cab
Generator
Floodlights (Preconnected)
Floodlights (Portable)
Battery Charging
SCBA
Portable Handlights
Water & Foam Tank Levels
Pump Engagement
Power Saws
Medical Equipment
Tires
Water Cooler
Apparatus Inventory
Use Inventory Sheet
Wash Apparatus
Good
Bad
6
7
8
9
10
11
12
13
14
15
Weekly Checks
Inspect Tires
Engine Oil Level
Coolant Level
Other Fluid Levels
Power Steering Fluid
Primer Oil
Transmission Fluid
Brake Fluid
Tilt Cab
Check Belt Condition
Check Belt Tension
Check Fluid Leaks
Check Battery Condition
Lower Cab & Lock
Drain Air Tanks
Engage Pump
Fire Extinguishers
Portable Generators
Windshield Wipers
Compartment Doors
Portable Saws
Rescue Tools
Hand Tools/Equipment
1
2
3
Monthly Checks
Ground Ladders
Hose
Clean Equip Compartments
1
2
3
4
5
Good
Bad
Driver Operator Signature:________________________ Company Officer Sgnature:_____________________
HORRY COUNTY FIRE/RESCUE
Ladder/Tower Maintenance Check-Off Sheet
CAREER PERSONNEL
Date: _______________________ APPARATUS NUMBER:_________________________________________
ASSET NUMBER:_____________________________ MILEAGE___________________________
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
1
2
3
4
Daily Checks
Apparatus Appearance
Fuel Level
Battery Voltage
Start Engine
Parking Brake
Emergency Equipment
-Emergency Lights
-Siren (Electronic)
-Siren (Mechanical)
-Air Horns
Headlights & Turn Signals
Radios
-Mobiles
-Portables
Cab
Generator
-Floodlights (Preconnected)
-Floodlights (Portable)
-Battery Charging
SCBA
Portable Handlights
Water & Foam Tank Levels
Pump Engagement
Power Saws
Medical Equipment
Tires
Water Cooler
Apparatus Inventory
-Use Inventory Sheet
Wash Apparatus
Weekly Checks
Inspect Tires
Engine Oil Level
Coolant Level
Other Fluid Levels
-Power Steering Fluid
-Primer Oil
-Transmission Fluid
-Brake Fluid
Good
Bad
Weekly Checks
5 Tilt Cab
-Check Belt Condition
-Check Belt Tension
-Check Fluid Leaks
-Check Battery Condition
6 Lower Cab & Lock
7 Drain Air Tanks
8 Engage Pump
9 Fire Extinguishers
10 Portable Generators
11 Windshield Wipers
12 Compartment Doors
13 Portable Saws
14 Rescue Tools
15 Aerial PTO
16 Operate Aerial Device
-Raise & Lower Device
-Extend and Retract Device
-Rotate Left & Right
-Check Electronic Nozzle
-Check Intercom System
-Check Cables and Pulleys
17 Hydraluic System
-Check oil filter
-Check hydraulic oil level
-Check hydraulic hoses
18 Hand Tools/Equipment
Good
Bad
Monthly Checks
1 Lubricate
-Jacks and outriggers
-Underside of extension arms
-Hoist cylinder and ladder pivots
-Aerial Slide sections
-Aerial rotation bearing
-Aerial pulleys and cable pulleys
2 Flow Water
3 Ground Ladders
4 Hose
6 Clean Equip Compartments
Driver Operator Signature:_______________________ Company Officer Signature:________________________
HORRY COUNTY FIRE/RESCUE
Utility, Brush, Mobile Air & Light Squad Maintenance Check-Off Sheet
CAREER PERSONNEL
APPARATUS NUMBER:_______________________________________ ASSET NUMBER:______________________________ MILEAGE______________________________
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Daily Checks
Apparatus Appearance
Engine Oil Level
Coolant Level
Other Fluid Levels
-Power Steering Fluid
-Primer Oil
-Transmission Fluid
-Brake Fluid
Fuel Level
Battery Voltage
Start Engine
Parking Brake
Emergency Equipment
-Emergency Lights
-Siren (Electronic)
-Siren (Mechanical)
-Air Horns
Headlights & Turn Signals
Radios
-Mobiles
-Portables
Cab
Generator
-Floodlights (Preconnected)
-Floodlights (Portable)
-Battery Charging
SCBA
Portable Handlights
Water Tank Level
Good
Bad
Comments
Daily Checks
Pump Engagement
Power Saws
Medical Equipment
Tires
Water Cooler
Apparatus Inventory
-Use Inventory Sheet
23 Wash Apparatus
Good
Bad
Comments
17
18
19
20
21
22
Weekly Checks
1 Inspect Tires
2 Engine Compartment
-Check Belt Condition
-Check Belt Tension
-Check Fluid Leaks
-Check Battery Condition
3 Fire Extinguishers
4 Portable Generators
5 Windshield Wipers
6 Compartment Doors
7 Portable Saws
8 Rescue Tools
1
2
3
4
Monthly Checks
Ground Ladders
Hose
Hand Tools/Equipment
Clean Equip Compartments
Driver/Operator Signature: _______________________________________ Company Officer Signature:______________________________________ Date: _________________
HORRY COUNTY FIRE/RESCUE
Ambulance Maintenance Check-Off Sheet
APPARATUS NUMBER:_____________________ ASSET NUMBER:_________________ MILEAGE__________________
Daily Checks
1 Apparatus Appearance
2 Engine Oil Level
3 Coolant Level
4 Other Fluid Levels
-Power Steering Fluid
-Transmission Fluid
-Brake Fluid
5 Fuel Level
6 Battery Voltage
7 Start Engine
8 Parking Brake
9 Emergency Equipment
-Emergency Lights
-Siren (Electronic)
-Air Horns
10 Headlights & Turn Signals
11 Radios
-Mobiles
-Portables
12 Cab
13 Inverter
Good Bad
Ambulance Crew Member Signature:
Comments
Daily Checks
Good Bad
Comments
14 SCBA
15 Portable Handlights
16 Medical Equipment
17 Tires
18 Water Cooler
19 Apparatus Inventory
-Use Inventory Sheet
20 Wash Apparatus
1
2
3
4
6
Weekly Checks
Engine Compartment
-Check Belt Condition
-Check Belt Tension
-Check Fluid Leaks
-Check Battery Condition
Fire Extinguishers
Windshield Wipers
Compartment Doors
Decon/Clean Equipment & Supply
Compartments
____________________________________________ Date: _______________________
HORRY COUNTY FIRE/RESCUE
Engine Maintenance Check-Off Sheet
VOLUNTEER PERSONNEL
APPARATUS NUMBER:_________________________ ASSET NUMBER:_______________________ MILEAGE:______________________
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Weekly Checks
Apparatus Appearance
Engine Oil Level
Coolant Level
Other Fluid Levels
Power Steering Fluid
Primer Oil
Transmission Fluid
Brake Fluid
Fuel Level
Battery Voltage
Start Engine
Parking Brake
Emergency Equipment
Emergency Lights
Siren (Electronic)
Siren (Mechanical)
Air Horns
Headlights & Turn Signals
Radios
Mobiles
Portables
Cab
Generator
Floodlights (Preconnected)
Floodlights (Portable)
Battery Charging
SCBA
Portable Handlights
Water & Foam Tank Levels
Pump Engagement
Good
Bad
Comments
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
Weekly Checks
Power Saws
Medical Equipment
Tires
Water Cooler
Apparatus Inventory
Use Inventory Sheet
Wash Apparatus
Inspect Tires
Tilt Cab
Check Belt Condition
Check Belt Tension
Check Fluid Leaks
Check Battery Condition
Lower Cab & Lock
Drain Air Tanks
Engage Pump
Fire Extinguishers
Portable Generators
Windshield Wipers
Compartment Doors
Portable Saws
Rescue Tools
Good
Bad
Comments
Monthly Checks
1 Ground Ladders
2 Hose
3 Hand Tools/Equipment
4 Clean Equip Compartments
Driver/Operator Signature:_______________________________ District Chief Signature:__________________________ Date: ______________
HORRY COUNTY FIRE/RESCUE
Ladder/Tower Maintenance Check-Off Sheet
VOLUNTEER PERSONNEL
APPARATUS NUMBER:_________________________________________ ASSET NUMBER:_____________________________ MILEAGE___________________________
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Weekly Checks
Apparatus Appearance
Engine Oil Level
Coolant Level
Other Fluid Levels
-Power Steering Fluid
-Primer Oil
-Transmission Fluid
-Brake Fluid
Fuel Level
Battery Voltage
Start Engine
Parking Brake
Emergency Equipment
-Emergency Lights
-Siren (Electronic)
-Siren (Mechanical)
-Air Horns
Headlights & Turn Signals
Radios
-Mobiles
-Portables
Cab
Generator
-Floodlights (Preconnected)
-Floodlights (Portable)
-Battery Charging
SCBA
Portable Handlights
Water & Foam Tank Levels
Pump Engagement
Power Saws
Medical Equipment
Tires
Water Cooler
Apparatus Inventory
-Use Inventory Sheet
Wash Apparatus
Inspect Tires
Good
Bad
Comments
Weekly Checks
25 Tilt Cab
-Check Belt Condition
-Check Belt Tension
-Check Fluid Leaks
-Check Battery Condition
26 Lower Cab & Lock
27 Drain Air Tanks
28 Engage Pump
29 Fire Extinguishers
30 Portable Generators
31 Windshield Wipers
32 Compartment Doors
33 Portable Saws
34 Rescue Tools
35 Aerial PTO
36 Operate Aerial Device
-Raise & Lower Device
-Extend and Retract Device
-Rotate Left & Right
-Check Electronic Nozzle
-Check Intercom System
-Check Cables and Pulleys
37 Hydraluic System
-Check oil filter
-Check hydraulic oil level
-Check hydraulic hoses
Good
Bad
Comments
Monthly Checks
1 Lubricate
-Jacks and outriggers
-Underside of extension arms
-Hoist cylinder and ladder pivots
-Aerial Slide sections
-Aerial rotation bearing
-Aerial pulleys and cable pulleys
2 Flow Water
3 Ground Ladders
4 Hose
5 Hand Tools/Equipment
6 Clean Equip Compartments
Driver/Operator Signature:_______________________________ District Chief Signature:__________________________ Date: ______________
HORRY COUNTY FIRE/RESCUE
Utility, Brush, Mobile Air & Light Squad Maintenance Check-Off Sheet
VOLUNTEER PERSONNEL
APPARATUS NUMBER:_________________________ ASSET NUMBER:___________________________ MILEAGE:_________________
1
2
3
4
5
6
7
8
9
10
11
12
13
14
Weekly Checks
Apparatus Appearance
Engine Oil Level
Coolant Level
Other Fluid Levels
-Power Steering Fluid
-Primer Oil
-Transmission Fluid
-Brake Fluid
Fuel Level
Battery Voltage
Start Engine
Parking Brake
Emergency Equipment
-Emergency Lights
-Siren (Electronic)
-Siren (Mechanical)
-Air Horns
Headlights & Turn Signals
Radios
-Mobiles
-Portables
Cab
Generator
-Floodlights (Preconnected)
-Floodlights (Portable)
-Battery Charging
SCBA
Good
Bad
Comments
25
26
27
28
29
30
Weekly Checks
Portable Handlights
Water Tank Level
Pump Engagement
Power Saws
Medical Equipment
Water Cooler
Apparatus Inventory
-Use Inventory Sheet
Wash Apparatus
Inspect Tires
Engine Compartment
-Check Belt Condition
-Check Belt Tension
-Check Fluid Leaks
-Check Battery Condition
Fire Extinguishers
Portable Generators
Windshield Wipers
Compartment Doors
Portable Saws
Rescue Tools
1
2
3
4
Monthly Checks
Ground Ladders
Hose
Hand Tools/Equipment
Clean Equip Compartments
15
16
17
18
19
20
21
22
23
24
Good
Bad
Comments
Driver/Operator Signature: __________________________ District Chief Signature: _____________________________Date: ________________