OFA Kit Checklist

• Kit Number

• Inspected Date and Time

  Date

• Inspected by

• Location
  Address

• Associated Vehicle (if applicable)

  AMB 1

  AMB 2

  ETV 1

  ETV 2

  ETV 3

General Job Information

• Client

• Job Site
  Address

• Take a photo of first aid kit

  Media

First Aid Kit Contents

• 14 cm x 19 cm WOUND CLEANSING TOWELETTES, INDIVIDUALLY PACKAGED • Qty : 24

  Yes

  No

• What is the current quantity?

• STERILE ADHESIVE DRESSINGS, ASSORTED SIZES, INDIVIDUALLY PACKAGED • Qty : 50

  Yes

  No

• What is the current quantity?

• 10 cm x 10 cm STERILE GAUZE DRESSING, INDIVIDUALLY PACKAGED • Qty : 20

  Yes

  No

• What is the current quantity?

• 10 cm x 16.5 cm STERILE PRESSURE DRESSING w/ CREPE TIES • Qty : 4

  Yes

  No

• What is the current quantity?

• 7.5 cm x 4.5 m CREPE ROLLER BANDAGE • Qty : 4

  Yes

  No

• What is the current quantity?

• COTTON TRIANGULAR BANDAGE, MINIMUM LENGTH OF BASE 1.25 m • Qty : 6

  Yes

  No

• What is the current quantity?

• 7.5 cm x 4 m CONFORMING GAUZE BANDAGES • Qty : 4

  Yes

  No

• What is the current quantity?

• 20 cm x 25 cm STERILE ABDOMINAL DRESSING, INDIVIDUALLY PACKAGED • Qty : 4

  Yes

  No

• What is the current quantity?

• 5 cm x 4.5 m ROLLS ADHESIVE TAPE • Qty : 2

  Yes

  No

• What is the current quantity?

• QUICK STRAPS (a.k.a. fracture or zap straps) • Qty : 4

  Yes

  No

• What is the current quantity?

• WINDLASS STYLE TOURNIQUET • Qty : 1

  Yes

  No

• 14 cm STAINLESS STEEL BANDAGE SCISSORS / UNIVERSAL SCISSORS • Qty : 1

  Yes

  No

• 11.5 cm STAINLESS STEEL SLIVER FORCEPS • Qty : 1

  Yes

  No

• POCKET MASK W/ ONE-WAY VALVE AND O2 INLET • Qty : 1

  Yes

  No

• PAIR OF MEDICAL GLOVES (preferably non-latex) • Qty : 6

  Yes

  No

• What is the current quantity?

• MEDICAL MASK (a.k.a. procedure/surgical mask) • Qty : 6

  Yes

  No

• What is the current quantity?

• SAFETY EYEWEAR OR FACE SHIELD • Qty : 2

  Yes

  No

• What is the current quantity?

• WATERPROOF WASTE BAG • Qty : 1

  Yes

  No

• PENLIGHT OR FLASHLIGHT • Qty : 1

  Yes

  No

• Blanket • Qty : 1

  Yes

  No

• First Aid Records (please record how many are left)

• Patient Assessment Forms (please record how many are left)

Oxygen Kit Contents

• PORTABLE O2 THERAPY UNIT CONSISTING OF: CYLINDER OF COMPRESSED O2, PRESSURE REGULATOR, PRESSURE GAUGE, FLOW METER, NON-REBREATHING MASK, NASAL CANNULA

  Yes

  No

• What is missing from the unit?

• OROPHARYNGEAL AIRWAY KIT • Qty : 1

  Yes

  No

• MANUALLY OPERATED SELF-INFLATING BAG-VALVE MASK w/ O2 RESERVOIR  • Qty : 1

  Yes

  No

• DIGITAL PULSE OXIMETER • Qty : 1

  Yes

  No

• PORTABLE SUCTION UNIT • Qty : 1

  Yes

  No

Kit Quality Check

• REFERENCE: First Aid Kit with good quality contents
  [This is an example of how you can use iAuditor to include best practice reference images in your templates to assist with inspections]

  

• Is there any defective item/s?

  Yes

  No

• Take photo of the defective items

  Media

• Are there any items soon to be expiring or that have already expired?

  Yes

  No

• Take photo of the expired items

  Media

Recommendation/Comments

• Any recommendations or notes you have about this kit?

Completion

• Inspector's Name and Signature

  Sign