Title Page
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Conducted on
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Prepared by
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Location
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Department:
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Name of PI (if applicable)
Box 1
General Information
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Name of First Aiders
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Are name, photo and contact no. being displayed?
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Number of first Aid box
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Location of box 1
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Individually wrapped sterile adhesive dressings - 20 no
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Crepe bandage (5 cm) - 1 no
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Crepe bandage (10cm) - 1 no.
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Absorbent gauze (packet of 10 pieces) - 5 No.
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Hypoallergenic tape - 1 No.
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Scissor - 1 pair
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Safety pins - 4 nos
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Disposable gloves (pairs) - 2 pairs
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Eye shield - 2 nos
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Eye pad - 2 nos.
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Resuscitation mask (one-way) - 1 no.
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Sterile water or saline in 100ml disposable containers (only when tap water is not available) - 1 no.
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Torch light (ensure working) - 1 no.
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Treatment log
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Other items ( e.g. Antidotes etc)
Box 2
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Location of box 2
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Individually wrapped sterile adhesive dressings - 20 nos.
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Crepe bandage (5cm) - 1 no.
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Crepe bandage (10 cm) - 1 no.
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Absorbent gauze (packets of 10) - 5 no.
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Hypoallergenic tape - 1 no.
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Triangular bandages - 4 nos.
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Scissors - 1 pair
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Safety pins - 4 nos
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Disposable gloves (pairs) - 2 nos.
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Eye shield - 2 nos
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Eye pad - 2 nos.
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Resuscitation mask (one-way) - 1 no.
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Sterile water or saline in 100ml disposable containers (only when tap water is not available) - 1 no.
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Torch light (ensure working) - 1 no.
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Treatment log
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Other item (e.g. Antidotes)
Box 3
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Location of box 3
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Individually wrapped sterile adhesive dressings - 20 nos.
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Crepe bandage (5cm) - 1 no.
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Crepe bandage (10 cm) - 1 no.
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Absorbent gauze (packets of 10) - 5 no.
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Hypoallergenic tape - 1 no.
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Triangular bandages - 4 nos.
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Scissors - 1 pair
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Safety pins - 4 nos
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Disposable gloves (pairs) - 2 nos.
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Eye shield - 2 nos
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Eye pad - 2 nos.
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Resuscitation mask (one-way) - 1 no.
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Sterile water or saline in 100ml disposable containers (only when tap water is not available) - 1 no.
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Torch light (ensure working) - 1 no.
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Treatment log
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Other item (e.g. Antidotes)
