Pennsylvania Department of Health Bureau of EMS QRS Inspection Checklist and Deficiency Notification

Sep 23, 2026

Uploaded by kopisore

Pennsylvania Department of Health Bureau of EMS QRS Inspection Checklist and Deficiency Notification provides a structured inspection form to verify EMS unit compliance and document findings. It captures agency and vehicle identifiers, inspection details, and regional EMS council information. The checklist defines deficiency key codes, lists critical out-of-service (OOS) criteria, and includes sections for vehicle equipment, clinical supplies, personal protective equipment, and optional items under Pennsylvania protocols, with columns for verified, deficient, corrected, and notes.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

AccessFree to download

QRS Inspection Details

Agency and Vehicle Identification

Deficiency Key and OOS Criteria

Vehicle and Equipment Verification

Required Vehicle Safety, Insurance, and Registration

Exterior and Interior Requirements

Airway, Suction, Oxygen, and Monitoring Supplies

Personal Protection and Optional Equipment

PPE and Infection Control Items

Optional Equipment per PA Protocols

Pennsylvania Department of Health Bureau of EMS QRS Inspection Checklist and Deficiency Notification (if required) | Name of EMS Agency: | | | | | | --- | --- | --- | --- | --- | | Dominant Lettering (as displayed on EMS unit): | | | | | | | | | | | | License Plate \# : | Year: | | | | | Vehicle Identification \# (VIN): | Make: | | | | | | Model: | | | | | | Unit \# (if applicable) | | | | | | Deficiency Key*:
B = Broken
E = Expired
M+\# = Missing- \# indicates how many items are missing (Ex. M1)
O = Other Include a note if using other | | | | | Date Inspected: | | | | | | Regional EMS Council: | | | | | | Name of Inspector(s): | | | | | | Critical Criteria for Out-of-Service (OOS) consideration (non-inclusive list) -Contact BEMS to place vehicle OOS | | | | | | | VERIFIED | DEFICIENT* | CORRECTED | NOTES | | Vehicle (if agency has vehicle) | | | | | | Current Pennsylvania Vehicle Safety Inspection | | | | | | Current Vehicle Insurance-digital copy is acceptable, if on tablet or computer that remains in vehicle | | | | | | Current Vehicle Registration-digital copy is acceptable, if on tablet or computer that remains in vehicle | | | | | | Exterior Markings (if agency has vehicle) | | | | | | DOH licensure decals on right and left exterior sides | | | | | | Legal Name or registered fictitious name in 3"+ letters on both right and left exterior sides | | | | | | Interior requirements (if agency has vehicle) | | | | | | No Smoking/Oxygen Equipped sign (1) in front | | | | | | Fasten Seat Belts sign (1) in front | | | | | | Ability to secure all bulky items when vehicle is in motion | | | | | | Radio Equipment (meets regional communication requirements) | | | | | | Equipment Required | | | | | | Current Version Statewide EMS Protocols-digital copy is acceptable, if on tablet or computer that remains in vehicle | | | | | | Portable Suction Unit (1) (300mm/Hg in 4 Sec.) Results: | | | | | | Suction catheters, rigid (2) | | | | | | Oropharyngeal airways (6 different sizes) | | | | | | Size 0 (1) | | | | | | Size 1 (1) | | | | | | Size 2 (1) | | | | | | Size 3 (1) | | | | | | Size 4 (1) | | | | | | Size 5 (1) | | | | | July 1, 2025 Bureau of EMS Ver. 1.0 1 Pennsylvania Department of Health Bureau of EMS QRS Inspection Checklist and Deficiency Notification (if required) | | VERIFIED | DEFICIENT* | CORRECTED | NOTES | | --- | --- | --- | --- | --- | | Nasopharyngeal (5 different sizes) | | | | | | Size 16 (1) | | | | | | Size 24 (1) | | | | | | Size 26 (1) | | | | | | Size 32 (1) | | | | | | Size 34 (1) | | | | | | Lubrication (2cc or larger tube, sterile water soluble) (2) | | | | | | Portable Oxygen with a minimum of 300 liters capacity (1) | | | | | | Non-sparking wrench/tank opening device (1) | | | | | | Full spare O2 cylinder with a 300 Liters capacity (1) | | | | | | Portable O2 cylinders secured in vehicle | | | | | | Adult nasal cannula (1) | | | | | | Pediatric nasal cannula (1) | | | | | | Adult high concentration mask (1) | | | | | | Pediatric high concentration mask (1) | | | | | | Infant high concentration mask (1) | | | | | | Adult Bag-Valve-Mask device (700cc) (1) | | | | | | Adult mask (1) | | | | | | Pediatric Bag-Valve-Mask device (450cc) (1) | | | | | | Child mask (1) | | | | | | Infant mask (1) | | | | | | Neonatal mask (1) | | | | | | Sphygmomanometer (interchangeable gauges are permitted) | | | | | | Child cuff (1) | | | | | | Adult cuff (1) | | | | | | Thigh (Large) cuff (1) | | | | | | Adult stethoscope (1) | | | | | | Pediatric stethoscope (1) OR (1) double bell with adult and pediatric bell | | | | | | Penlight (1) | | | | | | Multi-Trauma (10" x 30") (4) | | | | | | Occlusive (3" x 4") (4) | | | | | | Sterile Gauze Pads (4" x 4"

FAQs

What do the deficiency key codes (B, E, M#, O) mean on the checklist?

B indicates Broken items, E indicates Expired items, M# indicates Missing items (with the number of missing items shown), and O indicates Other; a note is required when using O.

What information must be recorded during the inspection?

The form requires EMS agency name, dominant lettering, license plate and year, vehicle identification number (VIN), vehicle make/model/unit number (if applicable), inspection date, regional EMS council, and inspector(s).

Which types of items does the checklist verify?

It verifies vehicle compliance items (safety inspection, insurance, registration, exterior/interior requirements), core clinical equipment and supplies (airways, suction, oxygen, airway devices, gauges, bandaging), and crew personal protective equipment, plus optional equipment listed under Pennsylvania protocols.

Sep 23, 2026

Uploaded by kopisore