Title Page
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Inspection Completed By:
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Confirm Site
Asset
First Aid Kit Visual Condition
First Aid Kit Condition
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Does the First Aid Kit appear in good condition Externally?
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Does the First Aid Kit appear in good condition Internally?
Individual Module Inspections
Food & Beverage Cuts (White Module)
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Has the tamper seal been broken?
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What has been used in this module?
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Is the use by date set to expire in the next 30 days?
Burns (Red Module)
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Has the tamper seal been broken?
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What has been used in this module?
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Is the use by date set to expire in the next 30 days?
Eye Wound (Blue Module)
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Has the tamper seal been broken?
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What has been used in this module?
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Is the use by date set to expire in the next 30 days?
Trauma (Yellow Module)
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Has the tamper seal been broken?
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What has been used in this module?
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Is the use by date set to expire in the next 30 days?
Dressing and Bandage (Purple Module)
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Has the tamper seal been broken?
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What has been used in this module?
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Is the use by date set to expire in the next 30 days?
Non-Modular Items
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2 or less boxes unopened boxes of Plasters are remaining?
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5 or less sachets of Burn Gel are remaining?
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5 or less unopened Conforming Bandages are remaining?
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Do you require any further Plasters, Burn Gels and Conforming Bandages and why? (Leave blank if nothing required)
Sign off
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I confirm that I have inspected and provided an accurate response to all questions and according to policies & guidelines.
