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Plat Mobil Ambulance Bulan NO Nama Barang Merk Jumlah 1 2 3

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CHECKL

Plat Mobil Ambulance : BM 7589 AY

Bulan :
NO Nama Barang MERK Jumlah 1 2 3

1 Oksigen PH 250 BAR 2


2 APAR PYROCHEM 1

3 Scoop stretcher
FERNO 1
4 Transport Stretcher FERNO 1
5 Spalk kaki - 1
6 Spalk tangan - 1
7 Urinal - 0
8 Pispot - 0

9 Tong sampah medis


- 0

10 Neck collar dewasa


- 2
11 Selimut - 1
12 Bantal
Lampu sorot - 1
14 PT. APB 2

15 Long spine board


- 0
16 Head stabilizer HEAD IMMOBILIZER MICO 1

Paraf Perawat UGD


Paraf Driver Ambulance
CHECKLIST PERALATAN AMBULANCE

4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
22 23 24 25 26 27 28 29 30 31
Mengetahui,
Koordinator Keperawatan

Buheri, S.Kep, Ns
C

Plat Mobil Ambulance : BM 7595 AY

Bulan :
NO Nama Barang MERK Jumlah 1 2 3

1 Oksigen PH 250 BAR 2


2 APAR PYROCHEM 1

3 Scoop stretcher
FERNO 1
4 Transport Stretcher FERNO 1
5 Spalk kaki - 2
6 Spalk tangan - 4
7 Urinal - 1
8 Pispot - 1

9 Tong sampah medis


- 1

10 Neck collar dewasa


STIF NECK 1
11 Selimut - 1
12 Bantal
Lampu sorot - 1
14 PT. APB 2

15 Long spine board


- 1
16 Head stabilizer HEAD IMMOBILIZER MICO 1

Paraf Perawat UGD


Paraf Driver Ambulance
CHECKLIST PERALATAN AMBULANCE

4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
20 21 22 23 24 25 26 27 28 29 30 31
Mengetahui,
Koordinator Keperawatan

Buheri, S.Kep, Ns
Plat Mobil Ambulance : BM 7598 AY

Bulan :
NO Nama Barang MERK Jumlah 1 2 3

1 Oksigen PH 250 BAR 2


2 APAR PYROCHEM 1

3 Scoop stretcher
FERNO 1
4 Transport Stretcher FERNO 1
5 Spalk kaki - 1
6 Spalk tangan - 1
7 Urinal - 1
8 Pispot - 1

9 Tong sampah medis


- 1

10 Neck collar dewasa


- 0
11 Selimut - 1
12 Bantal
Lampu sorot - 1
14 PT. APB 2

15 Long spine board


EXTRICATION DEVICE 1
16 Head stabilizer HEAD IMMOBILIZER MICO 1

Paraf Perawat UGD


Paraf Driver Ambulance
CHECKLIST PERALATAN AMBULANCE

4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
19 20 21 22 23 24 25 26 27 28 29 30 31
Mengetahui,
Koordinator Keperawatan

Buheri, S.Kep, Ns

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