Pharmacy Inspection Form

EMS Service:
Inspector Name:
Date of Inspection:

ALS SERVICE DRUG BOX


ALS Box# Vehicle#
Security Tag Number Is Box Secure?
1st Expiration Date: Medication Name:
Temperature Check
(Should be kept between 40/45 Farenheit)
Temp. Not Applicable

EPI & OVER the COUNTER MEDICATIONS


Vehicle#
(1) Adult Epi Auto-injector (0.3mg) Expires
(1) Pediatric Epi Auto-injector (0.15mg) Expires
Asprin (81mg chewables) Quantity 1st Expiration
Oral Glucose: Quantity 1st Expiration

Additional Information

By submitting this Inspection Form I verify that the identified drug box has been inspected per pharmacy control policies and procedures.
Submit an inspection form  for each vehicle Epi & OTC Meds are kept.
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Hope 4 Iowa

The HOPE 4 IOWA Crisis Call Line connects individuals in crisis to a helping hand and the resources to address and improve mental wellness. Available 24/7. For more information visit our website here.

 

 

 

 

 

 

 

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Pottawattamie County Emergency Notification System

Pottawattamie Alert is the countywide emergency notification system serving all residents within Pottawattamie County and its communities.

Part of the Alert Iowa System, Pottawattamie Alert is a high-speed notification and weather warning service. This no-charge service is available to businesses and residents of Pottawattamie County and its Communities that allows public officials to warn citizens of pending emergencies, critical public information during disasters, recommended protective actions, and provides automated severe weather warnings tailored to your preferences. The system can also be used to provide other important information to communities.

REGISTER TODAY – CLICK THE POTTAWATTAMIE ALERT LOGO