Title Page
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Conducted on
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Prepared by
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Location
Assignee Details
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Name
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Role
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Line Manager
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Date & Time
First Aid Checklist
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Does the Isopropyl Alcohol needs replacement?
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Have you reported to HSE when this was used?
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Fill-up and submit First Aid Usage Report and send to PH.HSE@syngenta.com.
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Does the 120ml Hydrogen Peroxide need replacement?
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Have you reported to HSE when this was used?
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Fill-up and submit First Aid Usage Report and send to PH.HSE@syngenta.com.
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Does the 15 mL Povidone Iodine need replacement?
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Have you reported to HSE when this was used?
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Fill-up and submit First Aid Usage Report and send to PH.HSE@syngenta.com.
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Does the 10 g cotton need replacement?
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Have you reported to HSE when this was used?
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Fill-up and submit First Aid Usage Report and send to PH.HSE@syngenta.com.
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Are there band-aids still available for use?
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Have you reported to HSE usage of the band aids?
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Fill-up and submit First Aid Usage Report and send to PH.HSE@syngenta.com.
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Are there still 3x3 gauze pads available for use?
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Have you reported to HSE usage of the 3x3 gauze pads?
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Fill-up and submit First Aid Usage Report and send to PH.HSE@syngenta.com.
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Are there still 2x2 gauze pads available for use?
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Have you reported to HSE usage of the 2x2 gauze pads?
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Fill-up and submit First Aid Usage Report and send to PH.HSE@syngenta.com.
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Are there still gauze bandages available for use?
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Have you reported to HSE consumption of the gauze bandages?
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Fill-up and submit First Aid Usage Report and send to PH.HSE@syngenta.com.
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Are there still plaster tape (1.25”x9m) available for use?
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Have you reported to HSE consumption of the plaster tape?
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Fill-up and submit First Aid Usage Report and send to PH.HSE@syngenta.com.
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Is the elastic bandage still available for use?
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Have you reported to HSE usage of the elastic bandage?
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Fill-up and submit First Aid Usage Report and send to PH.HSE@syngenta.com.
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Are there still wet wipes available for use?
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Have you reported to HSE usage of the wet wipes?
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Fill-up and submit First Aid Usage Report and send to PH.HSE@syngenta.com.
Replacement Summary - Tick here all items for replacement
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1 bot – 60 mL isopropyl alcohol 70% soln
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1 bot – 120 mL hydrogen peroxide
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1 bot – 15 mL povidone iodine
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1 roll – 10 g cotton
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1 box – bandaid (12pcs)
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2 pcs – 3x3 gauze pads
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2 pcs – 2x2 gauze pads
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2 roll – gauze bandage
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1 roll – plaster tape (1.25”x9m)
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1 roll – elastic bandage
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1 pc – wet wipes
Confirmation Page
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Please sign to confirm the report.
