INSPECTION ITEM AND REFERENCE COMPLY NON-COMPLY N/A. 1. Does organization have a written 68W sustainment program?

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1 APPENDIX P DEPUTY CHIEF OF STAFF MEDICAL STAFF ELEMENT: DCSMED SUB-FUNCTION: 68W Certification/Sustainment MOS Smartbook AR (26 FEB 04) TC (AUG 06) AND REFERENCE Major Subordinate Command (MSC) level 1. Does organization have a written 68W sustainment program? 2. Are personnel records of Emergency Medical Technician (EMT), Pre-Hospital Trauma Life Support (PHTLS) or Basic Trauma Life Support (BTLS) or Combat Medic Advanced Skills Training (CMAST) and Cardio Pulmonary Resuscitation (CPR) certification maintained? 3. Does unit track National Registery of Emergency Medical Technicians (NREMT) failures? 4. Is the training documented in Medical Operational Data System (MODS) for each individual soldier and each 68W registered for a personal MODS account? 5. Is there training system for personnel to acquire their 48hrs of Continued Education Units (CEUs) for EMT recertification? 6. Does organization have a written Annual Combat Medic Skills Validation Test (ACMS-VT) policy? 7. Are personnel records maintained for ACMS-VT semi-annual certification? 8. Is training annotated in MODS? Primary Inspection Sign and Date:

2 SUB-FUNCTION: Anthrax Vaccination Immunization Program for Medical Units TBD 1. Does the unit maintain a Anthrax program? 2. Is 90% or more of the unit up to date in MEDPROS for compliance with the anthrax immunization? 3. Are Emergency Essential Civilian (EEC)employees receiving the anthrax vaccination? 4. Do unit personnel know how to obtain information about the anthrax vaccination? 5. If a soldier refuses the anthrax immunization, the soldier is counseled and afforded due process under the UCMJ? 6. If EEC personnel refuse to take the anthrax immunization, is the Eighth U.S. Army G1 (Civilian Personnel branch) being contacted to provide assistance and guidance? 7. Does the unit commander (or designated unit personnel) know how to access the MEDPROS Web based immunization-tracking system to check on unit statistics for compliance with the anthrax vaccination immunization schedule? Following verified at the servicing MTF: 8. Are immunizations being recorded in Department of Health and Human Services Form PHS 731 (Shot Record), and the SF 601 (Immunization Record) and/or MEDPROS? 9. Are immunizations annotated on MEDCOM Form 700-R (Anthrax Vaccination Record), and placed in the soldier s medical record? 10. If a soldier or civilian has an adverse reaction to the anthrax vaccine, is it reported through the proper channels through completion of a Vaccine Adverse Event Reporting System(VAERS) and forwarded to the 121 st General Hospital Pharmacy IAW 18 th MEDCOM Policy #49, VAERS 11. Are personnel who are administratively or medically exempt from the anthrax immunization being annotated in MEDPROS? Primary Inspector Sign and Date:

3 SUB-FUNCTION: Combat Lifesaver Training Program AR (13 JAN 06) DA PAM (3 SEP 02) DA PAM (30 OCT 95) AR (22 JUN 04) 1. Does the unit maintain a CLS program? 2. Does the unit have a hard copy or disk of the following: a. AR b. DA PAM (enrollment for CLS) 3. Does the unit validate certification for CLS every 12 month's? 4. Does the unit monitor that certification/re-certification is maintained in the soldiers personnel records in accordance to AR ? 5. Does the unit monitor how many CLS's are assigned and require CLS program compliance? 6. Is a compliance inspection conducted annually for subordinate units? 7. Does the CLS program inspect if the CLS bags are stored correctly? 8. Does the CLS program inspection check to ensure expiration dates? and storage conditions are assured? 9. Does the CLS program inspection check to ensure the CLS bags components: Atropine and CANA are separated, accounted for and stored according to AR 40-61, Ch.9-7, (2) (d) and AR , Ch.4? 10. Does the unit correct deficiencies within 90 days? Primary Inspector Sign and Date:

4 SUB-FUNCTION: Dental Readiness Program AR 40-3 (3 APR 06) AR (2 AUG 04) 1. Unit has identified a unit level dental readiness NCO and alternate with access to MEDPROS to check on unit statistics for compliance? 2. Has the unit maintained a system that manages the monthly dental readiness report? 3. Does unit maintain a management system for in-processing soldiers? 4. Has the dental readiness NCO maintained a record of soldiers missing dental records? Has a copy been provided to unit commanders? 5. Are 95% of the units dental records accounted for in the dental clinic? 6. Does 95% of the units dental records have up to date annual dental examinations? 7. Is 90% or more of the unit up to date in MEDPROS for compliance with the dental readiness program? 8. Any dental record that is reported missing over two consecutive monthly reports is automatically classified as a Class IV. What is the total number of missing records for the two month period? OVERALL RATING: RECOMMENDATION/COMMENTS: Primary Inspector Sign and Date

5 SUB-FUNCTION: Field Sanitation Program AR 40-5 (22 JUL 05) AR (22 JUN 04) FM (28 AUG 00) FM (25 JAN 02) TB MED 507 TB MED 508 TB MED Does the unit maintain a Field Sanitation program? 2. Does the unit monitor if personnel are identified and Field Sanitation certified? 3. Is one of the Field Sanitation members an NCO and one Specialist or below IAW AR 40-5? 4. Does the unit monitor that certifications are maintained in the soldier's records in accordance to AR ? 5. Does the Field Sanitation program inspection check if required supplies are on hand, is there an active supply requisition? 6. Does the Field Sanitation program check if subordinate units are inspecting water containers? 7. Are water containers inspected 72 hours prior to any employments/re-deployments? 8. Does the Field Sanitation program check pesticide usage and was it recorded on DD Form ? 9. Does the Field Sanitation program check if pesticides are stored IAW DOD ? 10. Does the unit have hard copy or disk of the following references? AR 40-5, FM , TB MED 508, TB MED 507 and TB MED 530? 11. Is a compliance inspection check of subordinate units conducted annually? 12. Does the unit correct deficiencies within 90 days? Primary Inspector Sign and Dates:

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