First Aid Risk Assessment Form

First Aid Risk Assessment Form

Fill out this section completely to ensure a thorough assessment.

Assessor Information

Name

    Position

      Department

        Assessment Date

          Email

            Workplace Assessment

            Type of Work

              IndustrialManufacturingConstructionAgricultureHealthcare ServicesHospitality and TourismRetail, Warehouse and LogisticsAdvertisingTransportationResearchLaboratoryEducationFood and Beverage ServicesEmergency ServicesInformation Technology

              Nature of Hazards

                Potential Illnesses/Injuries and Likely Causes

                Illnesses/Injuries

                Causes

                First Aid Requirements

                Disposable Gloves

                Gown/Apron

                Masks

                Face Shields

                Resuscitation Devices

                Adhesive Bandages

                Sterile Gauze Pads

                Antiseptic Wipes

                Scissors and Tweezers

                Instant Cold Packs

                Sterile Eye Pads

                Elastic Bandages

                Disposable Thermometers

                Burn Dressings

                Sterile Saline Solution

                First Aid Facility Information

                Address

                  No. of Employees/Individuals

                    • Less than 50

                    • 50 - 100

                    • 100 - 200

                    • More than 200

                    Site Size

                      Site Layout

                        First Aid Officer to First Aid Kit Ratio:

                          • 1 officer 1 first aid kit

                          • 2 officers 4 first aid kits

                          • 3 officers 9 first aid kits

                          Certification

                          I, the undersigned, confirm that the information provided in this assessment is accurate to the best of my knowledge.

                          Name:

                          Date:

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