Children’s Health Express Mobile Medical Unit Ava Wood, BSN, RN, NE,BC Director, Ambulatory Care Lisa Butterworth, BSN, RN Clinical Program Manager

Children’s Health Express

Primary Care

DATE: _________________ DAILY PRE-TRIP INSPECTION ITEMS AREA COMPONENTINSPECTION  HEADLIGHTS Check operation  TURN SIGNAL LIGHTS Check operation  BRAKE LIGHTS Check operation  PARK BRAKE Check operation  REAR AXLE Check for leaks  SERVICE BRAKES Check operation  AIR TANKS W/AUTOMATIC EJECTORS Check operation  AIR DRYER OPERATION Check for operation  AIR CLEANER AIRFLOW RESTRICTION GUAGE Restriction indicator reading  MECHANICAL FAN DRIVE GEAR BOX Check for leaks  FUEL/WATER SEPARATOR Drain checking for presence of water  HYDRAULIC STEERING SYSTEM Check for leaks  STEERING WHEEL Check for excessive play  BODY DAMAGE INSPECTION Inspect body damage and note below Notes: Driver Signature:_____________________________

DATE: _________________ WEEKLY MOBILE VEHICLE INSPECTION ITEMS AREA COMPONENT INSPECTION  FRONT AXLE WHEEL BEARINGS Check oil level  BATTERIES/BATTERY CABLES Check for corrosion, loose connections  VISUAL INSPECTION OF FUSE PANELS Check for corrosion, blown fuses  ENGINE COOLING FAN Check for nicks, cracks, loose pieces  ENGINE OIL Check fluid level  ENGINE COOLANT LEVEL Check coolant level  ENGINE DRIVE AND ACCESSORY BELTS Check for wear  RADIATOR AND CHARGE AIR COOLER Presence of debris/damage  COOLANT HOSES, PIPES, AND CLAMPS Check for leaks, loose clamps, chafing  CHECK EXHAUST PIPING & MUFFLER Check that all components are secure  HYDRAULIC RESERVOIR Check fluid level  FRONT AIR SPRINGS Check wear and/or leaks  REAR AIR SPRINGS Check wear and/or leaks  FRONT SHOCKS Inspect for leaks  REAR SHOCKS Inspect for leaks  RIDE HEIGHT Check level  TRANSMISSION FLUID Check fluid level  TIRES Check and adjust air pressure, check for wear, damage  WHEELS Check wheel nuts Notes: Driver Signature:_____________________________