F77. First Aid Kit Inspection

Unique ID

SITE NAME

SITE LOCATION

Type of Kit

Frequency of Service

Last service date

Item

1. Adhesive Tape 2.5cm x 5m Zinc Oxide

Number Used (Adhesive Tape 2.5cm x 5m Zinc Oxide)

2. Adhesive Tape paper 2.5cmx5M

Number Used (Adhesive Tape paper 2.5cmx5M)

3. Antiseptic Cream

Number Used (Antiseptic Cream)

4. Antiseptic Wipes

Number Used (Antiseptic Wipes)

5. Band Aids – Packets

Number Used (Band Aids – Packets)

6. Burn Dressing – Large

Number Used (Burn Dressing – Large)

7. Burn Dressing – Small

Number Used (Burn Dressing – Small)

8. Burnaid Gel

Number Used (Burnaid Gel)

9. Cold/Heat Pack

Number Used (Cold/Heat Pack)

10. Combine Dressing 20x20cm

Number Used (Combine Dressing 20x20cm )

11. Conforming Bandage 10cm x 1.8m

Number Used (Conforming Bandage 10cm x 1.8m)

12. Conforming Bandage 5cm x 1.8m

Number Used (Conforming Bandage 5cm x 1.8m)

13. Conforming Bandage FAC 7.5cm x 1.8m

Number Used (Conforming Bandage FAC 7.5cm x 1.8m)

14. Cotton Buds 7.5cm

Number Used (Cotton Buds 7.5cm)

15. CPR Resuscitation Card

Number Used (CPR Resuscitation Card)

16. Crepe Bandage – Large

Number Used (Crepe Bandage – Large)

17. Crepe Bandage – Small

Number Used (Crepe Bandage – Small)

18. Crepe Medium Bandage 10cm x 2m

Number Used (Crepe Medium Bandage 10cm x 2m)

19. Crepe Medium Bandage 7.5cm x 2m

Number Used (Crepe Medium Bandage 7.5cm x 2m)

20. Cup Plastic Disposable 180ml 6oz each

Number Used (Cup Plastic Disposable 180ml 6oz each)

21. Disposable Gloves

Number Used (Disposable Gloves)

22. Dressing Pack Basic

Number Used (Dressing Pack Basic)

23. Emergency Thermal Blanket

Number Used (Emergency Thermal Blanket)

24. Eye Pad Single

Number Used (Eye Pad Single)

25. Eye Wash Solution

Number Used (Eye Wash Solution)

26. First Aid Booklet

Number Used (First Aid Booklet)

27. Gauze Pieces 7.5cm Sterile

Number Used (Gauze Pieces 7.5cm Sterile)

28. Gloves Latex Pair Large - Pre Packed

Number Used (Gloves Latex Pair Large - Pre Packed)

29. Healaid Cream

Number Used (Healaid Cream)

30. Kidney Dish Plastic Green 160mm

Number Used (Kidney Dish Plastic Green 160mm)

31. Magnifier Plastic

Number Used (Magnifier Plastic)

32. Non-Adherent Dressing 7.5X10cm

Number Used (Non-Adherent Dressing 7.5X10cm)

33. Non-Adherent Dressing 7.5X5cm

Number Used (Non-Adherent Dressing 7.5X5cm)

34. Notebook and Pencil

Number Used (Notebook and Pencil)

35. Penlight Disposable With Pupil Gauge

Number Used (Penlight Disposable With Pupil Gauge)

36. Plastic Bag Clip Seal Plain

Number Used (Plastic Bag Clip Seal Plain)

37. Pressure Pads

Number Used (Pressure Pads)

38. Register Of Injuries

Number Used (Register Of Injuries)

39. Resusi-Safe Shield Disposable

Number Used (Resusi-Safe Shield Disposable)

40. Safety Pins Assorted

Number Used (Safety Pins Assorted)

41. Saline 10ml Pods

Number Used (Saline 10ml Pods)

42. Scissor S/S 12.5cm Sharp/Blunt

Number Used (Scissor S/S 12.5cm Sharp/Blunt)

43. Sharps Disposal

Number Used (Sharps Disposal)

44. Splinter Probe Disposable

Number Used (Splinter Probe Disposable)

45. Thermometer

Number Used (Thermometer)

46. Triangular Bandage Disp 110cmx155cm

Number Used (Triangular Bandage Disp 110cmx155cm)

47. Triangular Bandage Disp 96 x 96cm

Number Used (Triangular Bandage Disp 96 x 96cm)

48. Tweezers

Number Used (Tweezers)

49. Wound Dressing No 15

Number Used (Wound Dressing No 15)

Total

Name

Signature

Date

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