Workplace First-Aid Readiness Assessment

Workplace First-Aid Readiness Assessment

Use this form to share your current first-aid staffing, equipment, and site hazards so we can assess your first-aid needs
Please complete this short assessment for each workplace/site. The information you provide will be used to evaluate first-aid readiness and recommend appropriate first-aid kits and training.
Business & Contact Details

Tell us who we should contact and which site this assessment applies to.
Business name*
Contact person name*

First NameLast Name
Email*
example@example.com
Phone number *
Site / location*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Workplace Overview

Basic details about your business and staffing.
Type of business / industry*
Workplace layout - multiple floors, remote buildings, shared sites.
Work patterns - 24 hours, shift work, lone working, remote locations
Number of employees at this site*
Number of currently first-aid trained staff*
Current first-aid resources

What you currently have on site.
Current number of first-aid kits on site*
Hazards & Special Training

Share any hazards or training needs specific to this site.
Common site hazards (select all that apply)

Working at heightsMachinery / moving partsChemicals / hazardous substancesElectrical hazardsHot works / burnsSharp tools / lacerationsManual handling / lifting injuriesSlips, trips, and fallsVehicles / forklifts / mobile plantRemote or lone workingConfined spacesBiological hazards (blood/body fluids)Extreme temperatures (heat/cold)Other
Site-specific hazards (describe)*
Write N/A if there aren't any
Is any special training required for this site?*

YesNoNot sure
If yes, describe the special training required
Additional notes (optional)
Should be Empty:

Workplace First-Aid Readiness Assessment

Business & Contact Details

Workplace Overview

Current first-aid resources

Hazards & Special Training