EMS Drug Bag Checklist
Complete this checklist to verify the contents and condition of the EMS drug bag at the start of your shift or after use.
Crew Member Name
*
First Name
Last Name
Employee ID
*
Date and Time of Inspection
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Unit/Vehicle Number
*
Location of Inspection
*
Drug Inventory Checklist
*
Rows
Present
Quantity
Expiration Date
Epinephrine 1:10,000
1
Aspirin
2
Naloxone (Narcan)
3
Nitroglycerin Tablets/Spray
4
Albuterol
5
Glucose (Oral)
6
Diphenhydramine
7
Atropine
8
Amiodarone
9
Other (specify in comments)
10
Are all drugs and supplies present and unexpired?
*
Yes
No (please specify below)
List any missing, damaged, or expired items (if applicable)
Additional Comments or Notes
Crew Member Signature
*
Submit Checklist
Submit Checklist
Should be Empty: