Form: DRC EQUIPMENT CHECKLIST.html,DRC EQUIPMENT CHECKLIST_Viewer.html
To:
Subject: DRC EQUIPMENT CHECKLIST LIST,
Msg:
DEPARTMENT OF HEALTH SERVICES COUNTY OF LOS ANGELES
(HOSPITALS) REFERENCE NO. 1102.2
SUBJECT: DRC EQUIPMENT CHECKLIST LIST,
RECEIVING FACILITY:
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ITEM Quantity On Hand Number Checked Out
Blankets/Sleeping Bags [ ] [ ]
CBRNE Monitoring Equipment [ ] [ ]
Chairs [ ] [ ]
Cots: Temps Beds [ ] [ ]
Simpler Life [ ] [ ]
Junkin Cots [ ] [ ]
Disposable Linen [ ] [ ]
Electrical Cords [ ] [ ]
Combine Chairs & various: Evacuation Equip [ ] [ ]
E-Z UP® Tents [ ] [ ]
Gas Cans with Fuel [ ] [ ]
HAM Radio [ ] [ ]
In-Line Heating System (for tents) [ ] [ ]
Isolation HEPA Filters [ ] [ ]
Medical/Surgical Supplies [ ] [ ]
Miscellaneous Supplies (rope, barrier tape,
work gloves, buckets, megaphone, etc.) [ ] [ ]
Outdoor Lighting [ ] [ ]
Pharmaceutical Cache [ ] [ ]
Portable Fans [ ] [ ]
Portable Honda Generators [ ] [ ]
Portable Sinks/Hand Washing Stations [ ] [ ]
Portable Toilet [ ] [ ]
Post - Decontamination Clothes [ ] [ ]
Tables (6-8 feet long) [ ] [ ]
Tents (18x24) [ ] [ ]
Tents (10x10) [ ] [ ]
Tent Lighting [ ] [ ]
Towable Generator (various types) [ ] [ ]
Towing Vehicle [ ] [ ]
Trailers [ ] [ ]
Ventilators [ ] [ ]
Vortran® Portable Vents [ ] [ ]
Vortran® Portable Vents [ ] [ ]
Weight Tubes [ ] [ ]
Other Supplies: [ ] [ ]
Communication Equipment – Walkie Talkies, Phones, etc. [ ] [ ]
Batteries – as need for each piece of equipment [ ] [ ]
Security Equipment – as needed per facility [ ] [ ]
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Comments/Notes
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Released by:
Date released:
Received by:
Facility:
Returned by:
Date returned:
Returned Items received by:
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Express Sending Station:
Senders Express Version:
Senders Template Version: