Title Page
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Conducted on
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Prepared by
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Location
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Site
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Name
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Date
Areas of work
General Information
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Does the site have a first aid room?
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If yes, complete Section 1 - First Aid Room
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Does the site have an AED (defibrillator)?
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If yes, complete Section 2 - AED
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Does the site have external inspectors to inspect the first aid kit?
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Has the first aid kit been inspected within the last two months?
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If no, complete Section 3 - First Aid Kits
Section 1 - First Aid Room
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Is there a first aid kit in the first aid room?
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Hygienic hand cleanser and disposable paper towels
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An examination lamp with magnifier
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A cupboard for storage
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A container with disposable lining for soiled waste
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A container for the safe disposal of sharps a bowl or bucket (minimum two litres capacity)
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Electric power points
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A chair and a table or desk
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A telephone and/or emergency call system
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Be located within easy access to a sink with hot and cold water
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(where this is not provided in the room) and toilet facilities
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Offer privacy via screening or a door
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Be easily accessible to emergency services (minimum door width of 1 metre for stretcher access)
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Be well lit and ventilated
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Have an appropriate floor area (14 square metres as a guide)
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Have an entrance that is clearly marked with first aid signage
Section 2 - AED
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AED is in signed location
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Ready light is Green
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Pads are in date and free from damage
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Battery is in date and free from damage
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External unit is free from damage
Section 3 - First Aid Kits
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Instructions for providing first aid – including Cardio-Pulmonary Resuscitation (CPR) flow chart
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Notebook and pen 1
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Resuscitation face mask or face shield 1
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Disposable nitrile examination gloves
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Gauze pieces 7.5 x 7.5 cm, sterile (3 per pack)
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Saline (15 ml)
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Wound cleaning wipe (single 1% Cetrimide BP)
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Adhesive dressing strips – plastic or fabric (packet of 50)
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Splinter probes (single use, disposable)
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Tweezers/forceps
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Antiseptic liquid/spray (50 ml)
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Non-adherent wound dressing/pad 5 x 5 cm (small)
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Non-adherent wound dressing/pad 7.5 x 10 cm (medium)
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Non-adherent wound dressing/pad 10 x 10 cm (large)
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Conforming cotton bandage, 5 cm width
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Conforming cotton bandage, 7.5 cm width
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Crepe bandage 10 cm (for serious bleeding and pressure application)
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Scissors
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Non-stretch, hypoallergenic adhesive tape – 2.5 cm wide roll
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Safety pins (packet of 6)
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BPC wound dressings No. 14, medium
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BPC wound dressings No. 15, large
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Dressing – Combine Pad 9 x 20 cm
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Plastic bags - clip seal
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Triangular bandage (calico or cotton minimum width 90 cm)
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Emergency rescue blanket (for shock or hypothermia)
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Eye pad (single use)
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Access to 20 minutes of clean running water or (if this is not available) hydro gel (3.5 gm sachets)
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Instant ice pack (e.g. for treatment of soft tissue injuries and some stings)
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Comments / Other Observations