FIRST AID KIT / UPK ISSUE 1/REV0

AFTER USE FORM

DATE: _______________________________

FLIGHT NO: _______________________________

SECTOR: _______________________________

NAME OF CUSTOMER: MR/MS _______________________________

SEAT NO OF CUSTOMER: _______________________________

MEDICATION GIVEN: _______________________________

REACTION TO MEDICATION (IF APPLICABLE): ____________________________

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RE-SEAL NO: _______________________________

NAME OF LEAD/CA: _________________________

STAFF NUMBER OF LEAD/CA: IGA_____________

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SIGNATURE OF LEAD / CREW

NOTE: THIS FORM IS TO BE FILLED IN DUPLICATE

COPY 1-LEAVE IN THE FIRST AID KIT BEFORE RE-SEALING THE KIT
COPY 2-ATTACH TO THE FLIGHT REPORT