Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Combine Pad 10cm x10 cm qty 2
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Have the pads expired
- No
- expired
- Close to expiry
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Combine pads 20 cm x 20 cm qty 2
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Have the pads expired?
- No
- expired
- Close to expiry
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Non Adherent Pad 20cm x 10cm qty 4
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Have the pads expired?
- No
- expired
- Close to expiry
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Non adherent pads 20 cm x 7.5cm qty 2
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Have the Pads expired
- No
- expired
- Close to expiry
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Emergency shock Blanket Qty 2
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Has the blanket expired?
- No
- expired
- Close to expiry
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Large Eye Pads qty 3
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Has eye pads expired ?
- No
- expired
- Close to expiry
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Small burns sheet qty 2
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Burns sheet expired?
- No
- expired
- Close to expiry
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Hospital Crepe 5cm qty 2
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Has bandage expired?
- No
- expired
- Close to expiry
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Hospital Crepe 7.5 cm qty 3
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Bandage expired?
- No
- expired
- Close to expiry
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Hospital Crepe 10 cm qty 3
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Bandage expired
- No
- expired
- Close to expiry
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Leukosilk Tape 5 cm qty 2
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Has tape expired?
- No
- expired
- Close to expiry
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Leukosilk Tape 2.5 cm? Qty 1
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Has tape expired?
- No
- expired
- Close to expiry
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Triangular bandage 110 cm x 110 cm qty 1
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Has the bandage Expired?
- No
- expired
- Close to expiry
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Plastic forceps qty 2
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Forced condition
- good
- broken
- missing
- contaminted
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If forceps not in good condition please throw them out and order a new pair by filling in a requisition.
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Disposable Towels in Bag qty 1
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Towel condition?
- Good
- torn
- contaminated
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Did you know you can requisition a new one if needed?
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Stainless steel scissors sharp/ blunt qty 1
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Scissors condition?
- good
- broken
- missing
- contaminted
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Safety Pins in tube qty 10
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
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Stainless Steel forceps 12.5 cm ( sharp)
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Latex Gloves in bag
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Adhesive shapes Bagged qty 50
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Eye Bath ( plastic)
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Condition of eye bath?
- good
- broken
- missing
- contaminted
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No 13 Wound Dressing qty 2
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Dressing out of date or contaminated
- Good
- Expired
- contaminted
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Burns Dressing Large qty 1
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Is the dressing out of Date?
- Good
- torn
- contaminated
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No15 Wound Dressing qty 2
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Dressing out of date or contaminated
- Good
- Expired
- contaminted
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Antiseptic lotion ( 50 ml) qty 1
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Lotion expired or empty?
- Full
- Empty
- Date expired
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If it is expired or empty fill in a few so we can get some new stuff. Never know when we will need it?
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Antiseptic steri tube 30 ml qty 6
- 0
- 1
- 2
- 3
- 4
- 5
- 6
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Antiseptic expired ?
- No
- expired
- Close to expiry
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Saline sachet 30 ml qty 6
- 0
- 1
- 2
- 3
- 4
- 5
- 6
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Is the saline out of date?
- No
- expired
- Close to expiry
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Assorted Plastic Bags qty 1 of ea
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Pencil qty 1
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Note pad qty 1
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Did you know stationery is in the office. If you can't find any put a note on the white board.
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Accident Record Form qty 3
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Pocket Mask qty 1
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Content list qty 1
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Remember anything missing, out of date or contaminated fill in a requisition.
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Any further information you would like to add.
