M113 Daily Check

2. M113 Daily Check

4. First Name

5. Last Name

6. Date*
   Date

8. Odometer*

   Miles

9. Due for Oil Change?*
   -- Select One --NoYesNo Sticker

   (typically every 5000 miles)

11. Fuel Level @ time of check*
    -- Select One --3/4 - full1/2 - under 3/4Below 1/2

12. Proper Fuel Cards for this Vehicle*

    1. Yes

    1. No

14. WCH Key Card*

    1. Yes

    1. No

    present? on turn signal?

15. iPad*

    present and charging

    1. Yes

    1. No
17. Emergency Lights and Sirens Functional*

    1. Yes

    1. No

18. Non-emergency Lights and Horn Functional*

    1. Yes

    1. No

20. Mirrors, Wipers & Seat Belts Adjusted & Fuctional*

    1. Yes

    1. No

21. Heat / Defrost / AC functional*

    1. Yes

    1. No

23. Fluids Check and/or Topped Off*

    1. Yes

    1. No

24. Tires and Wheels*

    proper PSI and wear

    1. Yes

    1. No
26. Brakes and Emergency Brake Functional and Set*

    1. Yes

    1. No

27. Unit Clean and Organized*

    1. Yes

    1. No

29. 800mhz Radios*

    all present / in chargers / on primary

    1. Yes

    1. No
30. Map Books / MA Books / Preplan Books / Fuel Card / Garage Opener*

    all present and stowed properly

    1. Yes

    1. No
32. SCBA present and >4000psi*

    1. Yes

    1. No

33. Shore Line Plugged In*

    1. Yes

    1. No

35. Main O2*

    must be above 300psi

36. Portable O2*

    must be above 500psi

38. Spare O2 cylinders X2*

    present and full / sealed

    1. Yes

    1. No
39. Clipboard*

    present and stocked with forms?

    1. Yes

    1. No
41. Cot Function*

    1. Raises / lowers properly

    1. Not functioning properly

42. Cot properly made*

    sheets, blanket, pillow w/ case & seat belts

    1. Yes

    1. No
44. Interior Supplies*

    if missing items note below

    1. Yes

    1. No
45. Outside Supplies*

    present and complete including extinguisher - if missing items please note below

    1. Yes

    1. No
47. ALS Bag*

    present, stocked and organized

    1. Yes

    1. No
48. First-In Bag*

    present, stocked and organized

    1. Yes

    1. No
50. UC Drug Bags

    1. Yes

    1. No

    present, stocked and sealed

52. UC Drug Bag #*

    1st bag - gold tag

53. UC Drug Bag #*

    2nd bag - gold tag

55. Broselow Bag*

    present, stocked and organized

    1. Yes

    1. No
56. Broselow Seal #*

58. Monitor Daily Check Completed?*

    either last night or during check

    1. Yes

    1. No
59. Monitor Batteries Charged?*

    1. Yes

    1. No

61. Batteries in Unit

    1. A

    1. B

    1. C

62. All Items Stocked in Monitor Bag?*

    1. Yes

    1. No

64. Items filled, repaired or fixed

66. Issues unable to be fixed during checks

    If needed - fill out a maintenance request please.

68. Issue Found?*
    -- Select One --An issue was presentNo issues noted

    Did you choose "No" for any answer above? Was fuel or water below 3/4?

69. Unit day today?*
    -- Select One --Unit 1Unit 2Unit 3

71. Your company officer today?*
    -- Select One --BC Chad CanuppLt. Ryan ChapmanCapt. John KingBC Jason KnollmanCapt. Matt KnollmanLt. Jon MeyerBC Rob MortonLt. Chris OakesLt. Matt OwenLt. Chris RobinsonLt. Scott SchmitsCapt. Jim Watkins

    If your station has no officer today, then choose the on-duty Battalion @ Station 113.

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73. Email address

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