Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Dressing Scissors (2)

  • How many of the item are needed to replace missing items?

  • Dressing Forceps (Tweezers) (2)

  • How many of the item are needed to replace missing items?

  • Safety Pins (24)

  • How many of the item are needed to replace missing items?

  • Cotton-Tipped Applicators (Q-tips)(50)

  • How many of the item are needed to replace missing items?

  • Adhesive Dressings - Sterile (60)

  • How many of the item are needed to replace missing items?

  • 3" Sterile Gauze Pads (48)

  • How many of the item are needed to replace missing items?

  • 3" Sterile Gauze Pads (48)

  • How many of the item are needed to replace missing items?

  • Rolls of 2" Gauze Bandages (8)

  • How many of the item are needed to replace missing items?

  • Rolls of 4" Gauze Bandages (4)

  • How many of the item are needed to replace missing items?

  • Absorbent Cotton - Cotton Balls (25)

  • How many of the item are needed to replace missing items?

  • Triangular Bandages (12)

  • How many of the item are needed to replace missing items?

  • Roll Up Splint

  • How many of the item are needed to replace missing items?

  • Splint Padding (2)

  • How many of the item are needed to replace missing items?

  • Sterile Surgical Pads for Pressure Dressings (4)

  • How many of the item are needed to replace missing items?

  • Cabinet for storing the dressings (1)

  • Garbage receptacle with lid (1)

  • Couch or bed to lie on (1)

  • Stretcher (1)

  • Blankets (2)

  • How many of the item are needed to replace missing items?

  • CPR Mask (1)

  • Roll of Adhesive Medical Tape (1)

  • Antiseptic Wipes (24)

  • How many of the item are needed to replace missing items?

  • Non-Latex Gloves - Size Small (2 pairs)

  • How many of the item are needed to replace missing items?

  • Non-Latex Gloves - Size Medium (2 pairs)

  • How many of the item are needed to replace missing items?

  • Non-Latex Gloves - Size Large (2 pairs)

  • How many of the item are needed to replace missing items?

  • Valid FIRST AID/CPR Manual

  • First Aid Reg 1101

  • Splinter Remover (5)

  • How many of the item are needed to replace missing items?

  • Ice Pack (10)

  • How many of the item are needed to replace missing items?

  • Burn Gel (10)

  • How many of the item are needed to replace missing items?

  • After Bite (10)

  • How many of the item are needed to replace missing items?

  • Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.