First Aid Kit Checklist

• Client / Site

• Conducted on

  Date

• Inspected by

• Location
  Address

Checklist

• Gauze pads (at least 4 x 4 inches)

  ✔

  ✖

  N/A

• Two large gauze pads (at least 8 x 10 inches)

  ✔

  ✖

  N/A

• Box adhesive bandages (band-aids)

  ✔

  ✖

  N/A

• One package gauze roller bandage at least 2 inches wide

  ✔

  ✖

  N/A

• Two triangular bandages

  ✔

  ✖

  N/A

• Wound cleaning agent such as sealed moistened towelettes

  ✔

  ✖

  N/A

• Scissors

  ✔

  ✖

  N/A

• At least one blanket

  ✔

  ✖

  N/A

• Tweezers

  ✔

  ✖

  N/A

• Adhesive tape

  ✔

  ✖

  N/A

• Latex gloves

  ✔

  ✖

  N/A

• Resuscitation equipment such as resuscitation bag, airway, or pocket mask

  ✔

  ✖

  N/A

• Two elastic wraps

  ✔

  ✖

  N/A

• Splint

  ✔

  ✖

  N/A

• Directions for requesting emergency assistance

  ✔

  ✖

  N/A

Completion

• Additional Supplies Needed (Y/N)

• Name and Signature of Inspector

  Sign