First Aid Kit Inspection Form
Institution's Informations
Institution Name
Institution Phone Number
Please enter a valid phone number.
Inspection Date
-
Month
-
Day
Year
Date
Officer's Signature
Clear
Institution Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Assesments
Equipments
Yes / No
Quantity
Notes
1" x 3" Adhesive Bandages
Yes
No
2" x 4 yds Roller Bandage
Yes
No
3" x 3" Sterile Pad
Yes
No
4" x 4 yds Roller Bandage
Yes
No
4" x 4" Burn Dressing, gel soaked
Yes
No
4" x 24" Splint
Yes
No
5" x 9" Trauma Pad
Yes
No
8" x 10" Gauze pads
Yes
No
40" x 40" x 56" Triangular Bandage
Yes
No
1/32 oz Burn Treatment
Yes
No
1/57 oz Antibiotic Treatment Application
Yes
No
1/57 oz Antiseptic Applications
Yes
No
0.9g Hand Sanitizer
Yes
No
2.5 yd Adhesive Tape
Yes
No
4 oz. Eye Wash
Yes
No
Alcohol swabs
Yes
No
Blanket
Yes
No
Breathing Barrier
Yes
No
Cold Pack
Yes
No
Crepe bandages
Yes
No
Elastic wraps
Yes
No
Elastic bandages
Yes
No
Eye Covering
Yes
No
Exam Gloves
Yes
No
First Aid Guide
Yes
No
Hand towels
Yes
No
Packet of 50 individually wrapped adhesive strips
Yes
No
Pair disposable gloves
Yes
No
Pair tweezers
Yes
No
Resuscitation mask
Yes
No
Roll adhesive tape, 1.25cm wide
Yes
No
Safety pins
Yes
No
Scissors
Yes
No
Small bottles of sterile eyewash solution
Yes
No
Sterile eye pads
Yes
No
Sterile coverings for serious wounds
Yes
No
Tourniquet
Yes
No
Triangular bandages
Yes
No
Tweezers
Yes
No
Wound dressings (Small sterile un-medicated)
Yes
No
Wound dressings (Medium sterile un-medicated)
Yes
No
Wound dressings (Large sterile un-medicated)
Yes
No
Other Findings & Comments
Inspection Agency Name
Agency Phone Number
Please enter a valid phone number.
Inspector's Name
First Name
Last Name
Inspector's Signature
Clear
Submit
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