DRC EQUIPMENT CHECKLIST

DEPARTMENT OF HEALTH SERVICES COUNTY OF LOS ANGELES
SUBJECT: DRC EQUIPMENT CHECKLIST LIST FOR ITEMS DEPLOYED TO OTHER FACILITIES		(HOSPITAL) REFERENCE NO. 1102.2
RELEASING DRC: RECEIVING FACILITY:

PURPOSE: To provide a mechanism for Disaster Resource Centers (DRC) to track DRC resources deployed to other facilities.
POLICY: The DRC shall utilize this checklist to document items deployed to other facilities.

Items	Quantity On Hand (Alt+Click to Edit)	Number Checked Out
Blankets/Sleeping Bags	75
Radiation Detection Equipment	2
Chairs	40
Stretcher with wheels	10
Surge bed/cots	30
Disposable Linen	50 Sets
Electrical Cords	4
Non-ambulatory Evacuation Equip	28
Pop Up Canopy	4
Gas Cans (5 gallon)	2
Isolation HEPA Filters	2 Units
Medical/Surgical Supplies	Per Policy 1107
Outdoor Lighting	2
Pharmaceutical Cache	Per Policy 1106
Portable Fans	4
Portable Sinks/Hand Washing Stations	2
Portable Toilets	2
Post - Decontamination Clothes (Adult)	40 Sets
Post - Decontamination Clothes (Pediatric)	10 Sets
Tables (6-8 feet long)	4
Tents	4
Decontamination Inserts	2
HVAC Units	4

SUBJECT: DRC EQUIPMENT CHECKLIST LIST FOR
ITEMS DEPLOYED TO OTHER FACILITIES

REFERENCE NO. 1102.2

Items	Quantity On Hand	Number Checked Out
Towable Generator (20 KW minimum)	1
Towing Vehicle (Prime mover)	1
Trailers	2
Vortran® Portable Vents	50 adult, and 5 Event Cases
Vortran® Portable Vents	20 pediatric, and 2 Event Cases
Notes/Comments

Released by:

Date released:

Received by:

Facility:

Returned by:

Date returned:

Returned Items received by:

Statement of Verification

I hereby verify that an inventory of all Grant funded items listed above has been completed and all items are up to PAR.

Verified By: Date:
(Printed Name and Signature)

Should any item on the above list fall below PAR levels, notify the EMS Agency immediately.

Notification to EMS Agency by: Date:

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