First Aid Supply Sign-Out Log Form
Use this form to log the sign-out and return of first aid supplies. Please complete all required fields for accurate tracking.
Name of Person Signing Out Supply
*
First Name
Last Name
Date and Time of Sign-Out
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
First Aid Item Taken
*
Please Select
Adhesive Bandages
Gauze Pads
Antiseptic Wipes
Medical Tape
Gloves
Scissors
Other
Quantity Taken
*
Expected Return Date (if applicable)
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Return Status
*
Returned
Not Returned
N/A (Consumable Item)
Date of Return (if applicable)
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Additional Notes
Submit Log Entry
Should be Empty: