First Aid Kit Monitoring Report
First Aid Kit Monitoring Report
First Aid Kit Monitoring Report
NUMBER OF
DATE & TIME OF REASON FOR USE SIGNATURE OF
NAME OF PERSON USE SUPPLIES (DESCRIPTION OF INCIDENT OR SYMPTOMS & TREATMENT PROVIDED) SUPERVISOR
CONSUMED
F-OHS-G03.2- V.0
FIRST AID SUPPLIES
REPLENISHMENT FORM
DIVISION: _________________________________________________
ITEMS QUANTITY
Adhesive bandages (band-aids)
Adhesive tape
Antiseptic applications: Betadine,
Hydrogen Peroxide
Cotton balls
Hand sanitizer or Alcohol
Elastic Roller Bandage, 2" x 4" or 5" yards
Elastic Roller Bandage, 4" x 4" or 5" yards
Scissor
Non Magnetic Twisser
Face Mask
Sterile Gauze, 2"x2"
Latex gloves
Breathing barrier
Burn treatment - ointment 25grms/5grm
Hot/Cold packs
Eye covering/pad
Eye wash, small
Splint
Trauma Pads
Triangular Bandage
REQUESTED BY:
Personnel In-Charge/Area Representative
NOTED BY:
DIVISION CHIEF
APPROVED BY:
SAFETY OFFICER
ADMIN DIVISION