HEALTH & SAFETY

MANAGEMENT
SYSTEM
FIRST AID RECORD Page 1 of 1
HSE-FORM NO.-REV
HSE-F109-1
Effective Date – 1.1.18

GENERAL INFO

LOCATION THE LIGHT CITY INSPECTION RESULT

PROJECT PLOT B SATISFACTORY

DATE 02-03-2024 POOR (TO REPLACE)

NO. CHECKLIST YES NO REMARKS

LOCATION
IS THE FIRST AID BOX LOCATED IN A
PROMINENT AND ACCESSIBLE POSITION /
AREA?
ARE EMPLOYEES INFORMED AND AWARE OF
THE LOCATION OF FIRST AID BOX?

DO ALL EMPLOYEES HAVE ACCESS TO THE

FIRST AID BOX DURING ALL WORK SHIFTD

IDENTIFIABILLITY
CAN THE FIRST AID BOX BE CLEARLY
IDENTIFIED AS A FIRST AID BOX?
IS THE FIRST AID BOX CLEARLY MARKED WITH
THE GREEN CRESCENT ON A WHITE
BACKGROUND?
CONTENTS
ARE THE CONTENTS APPROPRIATE TO THE
INJURIES AND ILLNESSES AT WORKPLACE?

DOES THE FIRST AID BOX CONTAIN SUFICIENT

QUANTITIES OF EACH ITEMS?
IS AN EMPLOYEE TRAINED IN FIRST AID
RESPONSIBLE FOR MAINTAINING THE FIRST AID
BOX?

ARE THE CONTENTS APPROPRIATE LABBLLED?

ARE THE CONTENTS WITHIN THEIR "USE BY"

DATE?

ARE THE CONTENTS ADEQUATELY STORED?

RELEVANT INFORMATION
IS THERE A LIST OF CONTENTS PROVIDED IN
THE FIRST AID BOX?

ARE EMERGENCY TELEPHONE NUMBERS

CLEARLY DISPLAYED?
ARE THE NAME, LOCATION AND EXTENSION
NUMBER OF THE NEAREST FIRST AIDER
CLEARLY INDICATED?
HAVE SELECTED EMPLOYEES RECEIVED
TRAINING IN THE USE AND MAINTENANCE OF
FIRST AID BOX

CHECKED BY : VERIFIED BY :

………………………………… ………………………….
( SSS / SHO / PIC ) ( PM / SA / PIC )
NAME: NAME :
 HEALTH & SAFETY
MANAGEMENT
SYSTEM
FIRST AID RECORD Page 2 of 1
HSE-FORM NO.-REV
HSE-F109-1
Effective Date – 1.1.18

FIRST AID BOX “USE BY” RECORD.

NO NAME TRADE DATE SIGNATURE REMARKS