Title Page

  • Site conducted

  • Conducted on (Date and Time)

  • Inspected by

  • Location

Bleeding and Wounds

  • Various size regular bandages

  • Two large gauze pads (8 x 10)

  • Gauze Dressing Pads (2x2, 4x4)

  • Triangular bandage

  • Gauze roll bandages (2 in and 4 in)

  • scissors

  • Eyewash (for wound irrigation)

Fever / Pain- On-Site not in Kit

  • Thermometer

  • Aspirin, Ibuprofen, Tylenol, Excedrin

Other Creams / Sprays / Ointments-- On-Site or in Kit

  • Antibiotic ointment

  • Antiseptic pads

OTC Meds- On-Site not in Kit

  • Allergy medicine

  • Nausea / diarrhea meds

  • Cold medicine

  • Antacid

  • Cough drops

Sprain / Break

  • Finger Splint

  • Cold Packs

Dehydration- On-Site not in Kit

  • Medi-Lyte- Water


  • Latex gloves

  • Tweezers

  • Adhesive tape

  • One blanket


  • Recommendations

  • Inspector (Name and Signature)

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