Crash Cart Checklist
Complete this checklist to verify the contents and readiness of the crash cart for emergency use.
Inspector Full Name
*
First Name
Last Name
Inspection Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Crash Cart Location/Unit
*
Please Select
Emergency Room
ICU
Operating Room
Pediatrics
Medical Ward
Other
Cart Seal Intact?
*
Yes
No
Medications and Fluids Check
*
Rows
Present & In Date
Missing/Expired
Epinephrine
1
2
Atropine
3
4
Amiodarone
5
6
Sodium Bicarbonate
7
8
IV Fluids
9
10
Other (specify in comments)
11
12
Airway Equipment Check
*
Rows
Present & Functional
Missing/Not Functional
Bag-Valve Mask
13
14
Oxygen Mask
15
16
Oral Airways
17
18
Suction Equipment
19
20
Other (specify in comments)
21
22
Defibrillator/AED Check
*
Present & Functional
Missing/Not Functional
IV Supplies Check
*
Rows
Present & In Date
Missing/Expired
IV Catheters
23
24
Syringes
25
26
Needles
27
28
Tourniquets
29
30
Alcohol Swabs
31
32
Cart Restocked After Use?
*
Yes
No
Additional Comments or Items Needing Attention
Inspector Signature
*
Submit Checklist
Submit Checklist
Should be Empty: