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SALISBURY RACECOURSE
MONTHLY KIT CHECK FORM
147
Questions
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1
Name of Staff Member Completing Checks
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Date and Time of Checks
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Minutes
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3
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4
M / L / XL Gloves
EARLIEST EXPIRY
-
Date
Day
Month
Year
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5
STOCK INFORMATION
CURRENT STOCK LEVEL
COMMENTS
Please Select
YES
NO
Please Select
Please Select
YES
NO
ANY STOCK DISPOSED?
QUANTITY
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
Please Select
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
REASON
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6
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7
Face Masks
EARLIEST EXPIRY
-
Date
Day
Month
Year
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8
STOCK
CURRENT STOCK LEVEL
COMMENTS
Please Select
YES
NO
Please Select
Please Select
YES
NO
ANY STOCK DISPOSED?
QUANTITY
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
Please Select
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
REASON
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9
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10
ADHESIVE DRESSINGS (SMALL)
EARLIEST EXPIRY
-
Date
Day
Month
Year
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11
STOCK
CURRENT STOCK LEVEL
COMMENTS
Please Select
YES
NO
Please Select
Please Select
YES
NO
ANY STOCK DISPOSED?
QUANTITY
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
Please Select
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
REASON
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12
ADHESIVE DRESSINGS (LARGE)
EARLIEST EXPIRY
-
Date
Day
Month
Year
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13
STOCK
CURRENT STOCK LEVEL
COMMENTS
Please Select
YES
NO
Please Select
Please Select
YES
NO
ANY STOCK DISPOSED?
QUANTITY
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
Please Select
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
REASON
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14
PLASTERS
EARLIEST EXPIRY
-
Date
Day
Month
Year
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15
STOCK
CURRENT STOCK LEVEL
COMMENTS
Please Select
YES
NO
Please Select
Please Select
YES
NO
ANY STOCK DISPOSED?
QUANTITY
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
Please Select
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
REASON
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16
STERI-STRIPS
EARLIEST EXPIRY
-
Date
Day
Month
Year
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17
STOCK
CURRENT STOCK LEVEL
COMMENTS
Please Select
YES
NO
Please Select
Please Select
YES
NO
ANY STOCK DISPOSED?
QUANTITY
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
Please Select
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
REASON
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18
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19
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20
XL BANDAGES
EARLIEST EXPIRY
-
Date
Day
Month
Year
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21
STOCK
CURRENT STOCK LEVEL
COMMENTS
Please Select
YES
NO
Please Select
Please Select
YES
NO
ANY STOCK DISPOSED?
QUANTITY
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
Please Select
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
REASON
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22
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23
M BANDAGES
EARLIEST EXPIRY
-
Date
Day
Month
Year
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24
L BANDAGES
EARLIEST EXPIRY
-
Date
Day
Month
Year
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25
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26
MISC BANDAGES
EARLIEST EXPIRY
-
Date
Day
Month
Year
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27
STOCK
CURRENT STOCK LEVEL
COMMENTS
Please Select
YES
NO
Please Select
Please Select
YES
NO
ANY STOCK DISPOSED?
QUANTITY
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
Please Select
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
REASON
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28
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29
ICE PACKS
EARLIEST EXPIRY
-
Date
Day
Month
Year
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30
STOCK
CURRENT STOCK LEVEL
COMMENTS
Please Select
YES
NO
Please Select
Please Select
YES
NO
ANY STOCK DISPOSED?
QUANTITY
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
Please Select
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
REASON
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31
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32
DRUGS BOX
PRESENT?
YES
NO
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33
PARACETAMOL
EARLIEST EXPIRY
-
Date
Day
Month
Year
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34
STOCK
CURRENT STOCK LEVEL
COMMENTS
Please Select
YES
NO
Please Select
Please Select
YES
NO
ANY STOCK DISPOSED?
QUANTITY
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
Please Select
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
REASON
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35
IBUPROFEN
EARLIEST EXPIRY
-
Date
Day
Month
Year
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36
STOCK
CURRENT STOCK LEVEL
COMMENTS
Please Select
YES
NO
Please Select
Please Select
YES
NO
ANY STOCK DISPOSED?
QUANTITY
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
Please Select
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
REASON
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37
LORATADINE/CETIRIZINE
EARLIEST EXPIRY
-
Date
Day
Month
Year
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38
STOCK
CURRENT STOCK LEVEL
COMMENTS
Please Select
YES
NO
Please Select
Please Select
YES
NO
ANY STOCK DISPOSED?
QUANTITY
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
Please Select
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
REASON
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39
ASPARIN
EARLIEST EXPIRY
-
Date
Day
Month
Year
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40
STOCK
CURRENT STOCK LEVEL
COMMENTS
Please Select
YES
NO
Please Select
Please Select
YES
NO
ANY STOCK DISPOSED?
QUANTITY
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
Please Select
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
REASON
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41
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42
TAPE / TUFF CUTS
(ANY STOCK ISSUES)
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43
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44
TRAUMA
EARLIEST EXPIRY
-
Date
Day
Month
Year
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45
STOCK
CURRENT STOCK LEVEL
COMMENTS
Please Select
YES
NO
Please Select
Please Select
YES
NO
ANY STOCK DISPOSED?
QUANTITY
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
Please Select
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
REASON
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46
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47
BURNS
EARLIEST EXPIRY
-
Date
Day
Month
Year
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48
STOCK
CURRENT STOCK LEVEL
COMMENTS
Please Select
YES
NO
Please Select
Please Select
YES
NO
ANY STOCK DISPOSED?
QUANTITY
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
Please Select
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
REASON
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49
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50
OBS KIT
(ANY STOCK / KIT ISSUES)
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51
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52
PPE - GLOVES AND SURGICAL MASKS
(ANY STOCK / KIT ISSUES)
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53
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54
PPE - FACE SHIELDS
(ANY STOCK / KIT ISSUES)
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55
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56
ADULT OXYGEN MASKS
EARLIEST EXPIRY
-
Date
Day
Month
Year
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57
STOCK
CURRENT STOCK LEVEL
COMMENTS
Please Select
YES
NO
Please Select
Please Select
YES
NO
ANY STOCK DISPOSED?
QUANTITY
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
Please Select
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
REASON
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58
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59
OP AIRWAYS
EARLIEST EXPIRY
-
Date
Day
Month
Year
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60
STOCK
CURRENT STOCK LEVEL
COMMENTS
Please Select
YES
NO
Please Select
Please Select
YES
NO
ANY STOCK DISPOSED?
QUANTITY
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
Please Select
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
REASON
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61
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62
ADULT BVM
EARLIEST EXPIRY
-
Date
Day
Month
Year
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63
STOCK
CURRENT STOCK LEVEL
COMMENTS
Please Select
YES
NO
Please Select
Please Select
YES
NO
ANY STOCK DISPOSED?
QUANTITY
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
Please Select
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
REASON
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64
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65
PAED RESUS (BVM AND NRB)
EARLIEST EXPIRY
-
Date
Day
Month
Year
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66
STOCK
CURRENT STOCK LEVEL
COMMENTS
Please Select
YES
NO
Please Select
Please Select
YES
NO
ANY STOCK DISPOSED?
QUANTITY
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
Please Select
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
REASON
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67
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68
SUCTION KIT
EARLIEST EXPIRY
-
Date
Day
Month
Year
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69
STOCK
CURRENT STOCK LEVEL
COMMENTS
Please Select
YES
NO
Please Select
Please Select
YES
NO
ANY STOCK DISPOSED?
QUANTITY
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
Please Select
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
REASON
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70
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71
SUCTION UNIT
PRESENT?
YES
NO
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72
SUCTION UNIT
BATTERY CHECK / POWER CABLE CHECK / BAG CHECK
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73
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74
PROPAQ MONITOR
BATTERY CHECK / POWER CABLE CHECK / BAG CHECK / CONSUMABLES CHECK
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75
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76
PPE - FFP3 MASKS AND GOGGLES
(ANY STOCK KIT ISSUES)
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77
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Submit
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78
PPE - APRONS AND COVID CLEANING WIPES
(ANY STOCK KIT ISSUES)
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79
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80
AED
PRESENT?
YES
NO
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81
AED
PAD 1 EXPIRY
-
Date
Day
Month
Year
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82
AED
PAD 2 EXPIRY
-
Date
Day
Month
Year
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83
AED
BATTERY CHECK / KIT CHECK / BAG CHECK
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84
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85
COUCH ROLL
PRESENT?
YES
NO
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86
COUCH ROLL
QUANTITY / ANY ISSUES
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87
BLANKETS
PRESENT?
YES
NO
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88
BLANKETS
QUANTITY / ANY ISSUES
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89
HEAD BLOCKS
PRESENT?
YES
NO
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90
HEAD BLOCKS
ANY ISSUES
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91
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92
RED RESPONSE BAG
PRESENT?
YES
NO
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93
EXTERNAL TOP POUCH -
TRAUMA / SUNDRIES
EARLIEST EXPIRY
-
Date
Day
Month
Year
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94
STOCK
CURRENT STOCK LEVEL
COMMENTS
Please Select
YES
NO
Please Select
Please Select
YES
NO
ANY STOCK DISPOSED?
QUANTITY
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
Please Select
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
REASON
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95
EXTERNAL BOTTOM POUCH -
OBS KIT
ANY STOCK / KIT ISSUES
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96
EXTERNAL SIDE POUCH -
ICE PACKS
EARLIEST EXPIRY
-
Date
Day
Month
Year
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97
STOCK
CURRENT STOCK LEVEL
COMMENTS
Please Select
YES
NO
Please Select
Please Select
YES
NO
ANY STOCK DISPOSED?
QUANTITY
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
Please Select
Please Select
OUT OF DATE
SEAL BROKEN
DAMAGED
REASON
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98
INTERNAL POUCH -
BANDAGES
LIST CURRENT STOCK AND EARLIEST EXPIRY
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99
INTERNAL POUCH -
DRESSINGS / PLASTERS
LIST CURRENT STOCK AND EARLIEST EXPIRY
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100
INTERNAL POUCH -
WOUND CLEANING
LIST CURRENT STOCK AND EARLIEST EXPIRY
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101
INTERNAL POUCH -
BURNS
LIST CURRENT STOCK AND EARLIEST EXPIRY
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102
INTERNAL POUCH -
AIRWAYS
LIST CURRENT STOCK AND EARLIEST EXPIRY
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103
INTERNAL POUCH -
BVM ADULT / PAED
LIST CURRENT STOCK AND EARLIEST EXPIRY
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104
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105
OXYGEN BAG
YES
NO
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106
CYLINDER EXPIRY
-
Date
Day
Month
Year
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107
OXYGEN BAG CONSUMABLES
LIST CURRENT STOCK AND EARLIEST EXPIRY
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108
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109
ENTONOX BAG
YES
NO
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110
CYLINDER EXPIRY
-
Date
Year
Month
Day
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111
ENTONOX BAG CONSUMABLES
LIST CURRENT STOCK AND EARLIEST EXPIRY
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112
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113
GREEN RUN ON BAG
YES
NO
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114
POUCH A - WOUND CLEANING
LIST CURRENT STOCK AND EARLIEST EXPIRY
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115
POUCH B - PLASTERS
LIST CURRENT STOCK AND EARLIEST EXPIRY
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116
POUCH C - ADHESIVE DRESSINGS
LIST CURRENT STOCK AND EARLIEST EXPIRY
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117
POUCH D - BANDAGES
LIST CURRENT STOCK AND EARLIEST EXPIRY
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118
POUCH E - ICE PACKS
LIST CURRENT STOCK AND EARLIEST EXPIRY
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119
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120
SCOOP STRETCHER
PRESENT?
YES
NO
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121
SCOOP STRETCHER
ANY ISSUES
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122
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123
WHEELCHAIR
PRESENT?
YES
NO
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124
WHEELCHAIR
ANY ISSUES
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125
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126
TEA BAGS
STOCK REQUIRED
STOCK NOT REQUIRED
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127
COFFEE
STOCK REQUIRED
STOCK NOT REQUIRED
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128
DECAF COFFEE
STOCK REQUIRED
STOCK NOT REQUIRED
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129
SUGAR
STOCK REQUIRED
STOCK NOT REQUIRED
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130
BISCUITS / SNACKS
STOCK REQUIRED
STOCK NOT REQUIRED
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131
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132
MOP AND BUCKET
PRESENT AND IN GOOD WORKING ORDER
YES
NO
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133
MOP AND BUCKET
ANY ISSUES
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134
LIQUID DISINFECTANT
STOCK REQUIRED
STOCK NOT REQUIRED
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135
CLINICAL WASTE BAGS
STOCK REQUIRED
STOCK NOT REQUIRED
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136
BLACK WASTE BAGS
STOCK REQUIRED
STOCK NOT REQUIRED
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137
AIR FRESHNER
STOCK REQUIRED
STOCK NOT REQUIRED
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138
WASHING UP LIQUID
STOCK REQUIRED
STOCK NOT REQUIRED
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139
DISH CLOTHS
STOCK REQUIRED
STOCK NOT REQUIRED
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140
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141
DRAWER 1 - WOUND CLEANING & PLASTERS
LIST CURRENT STOCK AND EARLIEST EXPIRY
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142
DRAWER 2 - OBS KIT
LIST CURRENT STOCK AND EARLIEST EXPIRY
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143
DRAWER 3 - DRESSINGS & BANDAGES
LIST CURRENT STOCK AND EARLIEST EXPIRY
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144
DRAWER 4 - ICE PACKS
LIST CURRENT STOCK AND EARLIEST EXPIRY
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145
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146
ANY FURTHER COMMENTS
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