Name of Teacher/Employee: _______________________________________________ Grade and Section/Office: __________________________________
School: _______________________________________________ Name of School Head: __________________________________
_____ First Aid Instruction Manual
Part 1: Classroom/Office Safety Checklist (Put if available) _____ Battery Powered Flashlights _____ Batteries _____ Classroom has number displayed and easily read _____ Buckets _____ Classroom door opens outward from inside the classroom _____ Duck Tape _____ Classroom door lock works _____ Emergency Backpack _____ Classroom windows have blinds or other type of covering _____ Utility Gloves _____ Classroom windows locks functions and can be secured _____ Food and Water _____ Room lights are in working order with good illumination _____ Blankets _____ Telephone or Intercom access is near the teacher’s desk _____ Ropes _____ Phone directory or listing is current and accessible _____ Fire Extinguishers _____ Emergency phone numbers are readily accessible to all _____ Others (please specify) _____ Phone usage instructions are clearly posted _____________________________________________ _____ First aid kit or supplies are stocked and location identified _____________________________________________ _____ Severe weather and sheltering maps are posted _____________________________________________ _____ Evacuation and sheltering maps have been discussed with learners/co-employees _____ Nearest fire extinguisher is located and more than one person knows how to use it Part 4: First Aid Supply Checklist (Put if available) _____ Freestanding bookcases and cabinets more that 4feet tall are secured to the wall _____ Television and other large electronic equipments is secured to a wall mount or stable stand _____ 4x4 Compress ______ pcs _____ The room is free from any trip hazards of obstructions _____ 8x10 Compress ______ pcs _____ All learners are wearing Updated Identification Card _____ Elastic Bondage ______ pcs _____ Triangular Bondage ______ pcs Part 2: Teacher/Employee Information Checklist (Put if applicable) _____ Splints ______ pcs _____ Butterfly Bondage ______ pcs _____ Reviewed All Hazard Emergency Operations Plan _____ Bottled Water ______ pcs _____ Reviewed Emergency Response Handbook, Flip Chart, Cards, etc. _____ Hydrogen Peroxide ______ pcs _____ Reviewed Evacuation Plan and Sheltering Instructions _____ Bleach ______ pcs _____ Checked Location of First Aid Supplies _____ Medical Scissors ______ pcs _____ Checked Emergency Backpack with Supplies _____ Tweezers ______ pcs _____ Reviewed Map of School with Legend _____ Triage Tags ______ pcs _____ Checked Fire Extinguisher locations _____ Latex Gloves ______ pcs _____ Reviewed Classroom/Office Seating Chart _____ Cloth Tape ______ pcs _____ First Aid Books ______ pcs Part 3: Classroom/Office Emergency Supply Checklist (Put if available) _____ Others (please specify) _____________________________________________ _____ List of Emergency Procedure _____________________________________________ _____ Whistle and Hard Hats _____________________________________________ _____ First Aid Supplies