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
Workplace Assessment
Type of Work
Nature of Hazards
Potential Illnesses/Injuries and Likely Causes
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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
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Less than 50
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50 - 100
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100 - 200
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More than 200
Site Size
Site Layout
First Aid Officer to First Aid Kit Ratio:
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1 officer 1 first aid kit
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2 officers 4 first aid kits
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3 officers 9 first aid kits
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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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