This record is used to track Blue Plaster. Circle response Yes/No as appropriate
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Site conducted
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Conducted on
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Prepared by
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Location /area
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This record is used to track Blue Plaster. Circle response Yes/No as appropriate
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Date
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Time of use
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Record the person’s name blue plaster issued to
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Manager: have you written the casualty initials on the plaster?
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Manager: have you explained to the casualty what they should do if plaster is lost?
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Manager: signature after issue
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At the end of the shift: was blue plaster returned, removed and safely disposed?
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Did the person leave the production facility with blue plaster on?
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Manager signature at end of day
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Person checked the following morning: if plaster present removed and reissued (start newline)
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Manager signature after morning check
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This record is used to track Blue Plaster. Circle response Yes/No as appropriate
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Signed off by Manager on completion
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Signature