CONTENTS

Construction Site Safety

26. First Aid at Work

Introduction
If possible:
First aid at work is covered by the Health and
Safety (First Aid) Regulations 1981, an Approved
Remove the cause from the patient or
Code of Practice, and a set of guidance notes
the patient from the cause
which provide further information on such matters
as first aid equipment and training. Start the heart
The regulations provide a flexible framework within
which employers can develop effective first aid Start the breathing
arrangements appropriate to their workplace and
the size of their workforce. Stop the bleeding

The Code of Practice sets out the criteria for the Keep the patient warm
provision of trained personnel, equipment and
facilities, and suggests four main factors which will YOU MAY SAVE A LIFE
influence decisions:
• the number of employees
• the nature of the undertaking References
• the size of the establishment and HSE publications
distribution of employees
L74 First aid at work: Health and Safety (First Aid)
• the location of the establishment and the Regulations 1981. Approved Code of Practice
locations to which employees go in the
course of their work. INDG 214 First aid at work: Your questions
answered
Reference
L74, Section 3, Paragraph 9 INDG 215 Basic advice on first aid work
Other publications
Legislation The First Aid Manual of St John Ambulance, St
The Health and Safety at Work Act 1974 Andrew’s Ambulance Association, The British Red
Cross Society. 6th edition 1993
The Health and Safety (First Aid) Regulations
1981
The Construction (Health, Safety and Welfare)
Regulations 1996
The Management of Health and Safety at Work
Regulations 1999

© Construction Industry Training Board GE 700/26

March 1998
CONTENTS
Definition of first aid
First aid is defined in the regulations as follows:
a) in cases where a person will need help
from a doctor or a nurse; treatment for
the purpose of preserving life and
minimising the consequences of injury
or illness until such help is obtained.
b) treatment of minor injuries which would
otherwise receive no treatment or which
do not need treatment by a doctor or
nurse.
It should be noted that the definition covers all
illness at work and not just accidents. You must,
therefore, plan for times when someone has a
heart attack or just collapses.
Reference
The Health and Safety (First Aid) Regulations
1981 Regulation 2(1)
Duty of employers
The duty placed on an employer is to:
• provide adequate first aid equipment and
facilities appropriate to the type of work or
operations undertaken
• appoint a sufficient number of suitable and
trained people to render first aid to
employees injured or who become ill at
work
• appoint a sufficient number of suitable
people who, in the temporary absence of
the first aider, will be capable of dealing
with an injured or ill employee needing help
from a medical practitioner or nurse, and of
taking charge of first aid equipment and
facilities
• inform employees of the first aid
arrangements, including the location of
equipment and personnel. This will require
that notices be posted and signs displayed.
Reference
The Health and Safety (First Aid) Regulations
1981, Regulations 3&4
26/2
FIRST PAGE
Shared facilities
To avoid the unnecessary duplication of facilities
where employees of more than one employer are
working together, arrangements may be made to
share facilities. For example, where several
contractors are working together on a building or
construction site, it may be that all necessary first
aid arrangements will be made either by the main
contractor, or the contractor with the most
employees on site.
Whilst there is now no requirement for shared
facilities to be recorded, industry best practice
dictates that the arrangements may be recorded in
writing on Form F2202 Register and Certificates of
Shared Welfare Arrangements, or another such
book or format, with each employer retaining a
copy.
In such circumstances, it is the responsibility of
each employer to ensure that the agreed facilities
are actually provided, and that all of their
employees are aware of these arrangements.
Reference
L74 Section 3, Paragraphs 21 & 22
Self-employed persons
Self-employed persons must provide adequate
first aid equipment for themselves. Where the use
of potentially dangerous tools and machinery
present a hazard, a proper first aid kit should be
provided. If a self-employed person is working
under an employer or with another self-employed
person, it is the responsibility of each of these to
provide first aid equipment. To avoid duplication,
shared facilities may be used, subject to the
procedures described above.
Reference
The Health and Safety (First Aid) Regulations
1981, Regulation 5
L74, Section 5, Paragraphs 66 & 67
Trained and suitable personnel
First aiders must have received training and hold a
current first aid certificate issued by an
organisation or employer approved by the Health
and Safety Executive for the purpose of the
regulations.
CONTENTS
Where first aiders have received first aid
instruction relating to special or unusual hazards
in the workplace, they should undergo refresher
training and re-examination as necessary. A
written record must be kept of such training by the
employer.
Other persons not holding a certificate as
described above, but with training and
qualifications approved by the HSE for the
purposes of the regulations, may be counted as
and act as first aiders.
A list of organisations approved for first aid training
and qualifications is obtainable from HSE area
offices (see Annexe A to this publication).
Reference
The Health and Safety (First Aid) Regulations
1981, Regulation 3(2)
L74, Section 3, Paragraphs 48–51
Number of first aiders required
The regulations and Code of Practice do not
specify numbers but set out guidelines in respect
of the number of first aiders needed, dependent on
the size of undertaking, the hazards present and
the number of people employed.
In determining the total number of first aid
personnel required, additional factors should be
considered. These are:
• the type of work or operations being carried
out
• whether or not employees work in scattered
and isolated locations
• whether there are special or unusual
hazards
• whether or not there is shift work.
On building or construction sites where up to 50
employees are working, at least one first aider
should be present. A further first aider is required
for every additional 50 or so employees. Where
there is shift working, enough first aiders should
be appointed to cover each shift.
Unless other arrangements have been made, as
indicated previously, each contractor or
sub-
FIRST PAGE
contractor on the site must make their own
provisions.
On sites where special or unusual hazards are
present, a proportionately larger number of first
aiders, having regard to the factors already
mentioned, will be needed.
Reference
L74, Section 3, Paragraphs 44–46
Appointed persons
An appointed person is someone who has been
authorised by management to take charge of a
situation, e.g. to call an ambulance if there is a
serious illness or injury.
They will act in the absence of the trained first
aider or in situations where a first aider is not
required, such as in a small non-hazardous
working area.
Emergency first aid training should be considered
for all appointed persons.
These persons are not to be regarded as an
acceptable alternative to first aiders, other than on
sites employing less than five employees where no
special or unusual hazards exist and there is an
easy access to outside accident and emergency
facilities.
The ‘appointed person’ is responsible for first aid
equipment in the absence of the first aider or in
the circumstances described above.
Reference
L74, Section 3, Paragraphs 58–61
Equipment and facilities
Location of first aid facilities
It is essential that all employees should have quick
and easy access to first aid facilities on site.
Where employees are working in large numbers
and in fairly close proximity, facilities should be
centralised in that area. When employees are
spread over a wider area, it will be necessary to
distribute first aiders and equipment accordingly.
In some circumstances, a combination of these
arrangements may be
26/3
CONTENTS
appropriate. All employees must be aware of the
location of first aid facilities and the arrangements
for providing treatment.
First aid Emergency
eye wash
First aid boxes
Every employer must provide one or more first aid
boxes. They should be strategically placed and
must be readily accessible and clearly marked with
a white cross on a green background, in
accordance with the Safety Signs Regulations
1980. The container should hold first aid
equipment and nothing else, and should protect
the contents from dust and damp.
Medicines, pressure bandages, dirty dressings
and home remedies must not be kept in first aid
boxes. Medicines, even those on general sale, are
not first aid items. The exclusion of medicine from
first aid boxes will ensure that nothing will be given
to injured or ill persons that could worsen their
condition.
First aiders must not give medicine to anyone.
They are legally restricted to the provision of first
aid treatment only, that is, treatment in accordance
with the training they have received.
It is essential that the contents of first aid boxes
are replenished after use and checked frequently
by the first aider or appointed person. Some of the
items are prone to deterioration after a certain
period. The contents of the first aid box are listed
in Appendix A.
First aid kits
Special or small travelling first aid kits should be
provided to those employees:
• who are working alone or in small groups in
isolated locations, e.g. maintenance gangs
26/4
FIRST PAGE
• whose work involves long distance travel in
remote areas
• who use potentially dangerous tools or
machinery.
The first aid kit should only contain the items as
described in Appendix A.
Instruction in emergency first aid, such as
resuscitation, control of bleeding, treatment of
unconsciousness, etc. is desirable for all
personnel.
General first aid guidance for untrained people is
given in the HSE publication, ‘Basic advice on
first aid at work’. The guidance notes are set out
in Appendix C.
Supplementary equipment
Where first aiders are employed, stretchers or
appropriate carrying equipment, such as a
carrying chair or wheelchair, should be provided in
an accessible location clearly identified by a sign.
If a site covers a large area, or contains a number
of distinct working areas, it will be necessary to
provide such equipment at a number of suitable
locations.
White symbol and letters
on a green
background
First aid rooms
On a large building or construction site, a first aid
room, suitably staffed and equipped, should be
provided. The need for such a room cannot be
decided purely on the numbers of persons
employed, but should be assessed on the type of
work being carried out and whether hospital or
other emergency facilities are close to hand.
CONTENTS
The first aid room will normally be under the
control of the first aider who should be nearby or
on call, with access to the room when employees
are at work. Their name should be displayed
together with the names and locations of all other
first aiders and appointed persons.
The room should be clearly identified, available at
all times and used only for rendering first aid. It
should be of sufficient size to contain a couch with
adequate space around it to allow people to work,
and provided with an access door to allow the
passage of a stretcher or other carrying
equipment. Pillows and blankets should be
provided and be frequently cleaned. The room
itself should be cleaned each working day, have
smooth-topped impermeable working surfaces and
provision for refuse disposal.
Heating, lighting and ventilation should be
effective. In addition to the first aid materials (see
Appendix A) which should be stored in a suitable
cabinet, there should be:
• a sink with running hot and cold water
• drinking water
• soap, nail brush and paper towels
• clean garments for use by first aid
personnel
• a clinical thermometer.
In first aid rooms that are supervised by doctors or
nurses, other items may be provided on their
advice.
The room should have a telephone, where
possible, and a siren or klaxon to alert personnel
on call.
A sufficient number of first aiders should be
provided in any work area which is not within easy
reach (approximately three minutes) of the first aid
room.
Reference
The Health and Safety (First Aid) Regulations
1981, Regulations 3(1), 4
L74, Section 3, Paragraphs 28–43
FIRST PAGE
Training and qualifications
The employer is responsible for ensuring that
those people who have been selected as first
aiders and occupational first aiders have
undergone training and possess qualifications
approved by the Health and Safety Executive.
Additional training may be necessary to cope with
any special hazards in a particular working
environment.
Reference
The Health and Safety (First Aid) Regulations
1981, Regulation 3(2)
Initial selection of first aiders
Whilst it may be desirable that first aid personnel
should be appointed from those who have already
received training (i.e. State Registered or State
Enrolled Nurses), on most sites it is unlikely that
they will be available, and it will be necessary to
recruit from existing staff.
In selecting persons for this role, the following
factors should be considered:
• friendly, reassuring disposition
• acceptable to male and female staff
• motivated by a desire to assist others
• able to remain calm in an emergency
• employed on a task which they can leave
immediately in order to go to the scene of
an emergency
• capable of acquiring the knowledge and
qualifications required.
Approval of training programmes
Any organisation or individual employer can seek
approval to train first aiders, examine them and
award certificates of qualification in first aid. The
HSE’s criteria for approval includes the following:
a) a syllabus which will include both
theoretical and practical work and which
must conform with the guidance issued
by them
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CONTENTS
b) suitable arrangements for conducting
examinations
c) examinations that must be conducted
by suitably qualified independent
examiners not involved in the training of
those being examined
d) a programme of examinations which is
appropriate
e) qualified instructors conforming to the
guidance issued by the HSE
Full details of the procedures for seeking approval
can be obtained by writing to:
The Chief Employment Nursing Adviser
Employment Medical Advisory Service
Health and Safety Executive
Room 615
Daniel House
Stanley Road
Bootle
Merseyside L20 7HE
Tel no: 0151 951 4000
For companies with insufficient resources to
provide their own training, a list of organisations
and individual employers approved by the Health
and Safety Executive is maintained. More
information can be obtained from the regional
offices of EMAS which are attached to regional
offices of the HSE (see Annexe A).
Various national organisations offer both full-time
(three or four days) and part-time (evening class)
first aid courses, as do some colleges, training
establishments, area health authorities and major
companies.
Training of first aiders
Training courses, including examinations, normally
take four full days or the equivalent.
The following subjects are included in the
syllabus:
• resuscitation
• control of bleeding
• treatment of shock
• treatment of an unconscious patient
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FIRST PAGE
• dressing and immobilisation of injured parts
of the body
• contents of first aid boxes and their uses
• transport of sick and injured persons
• recognition of illness
• treatment of injuries
• treatment of burns and scalds
• simple record keeping
• poisons, and substances capable of
poisoning
• personal hygiene in dealing with wounds
• communication and delegation in an
emergency
It may be necessary to provide specialised
instruction in the use of protective equipment or
rescue techniques, etc. where these are important
in the trainees workplace or if special hazards exist
there.
Certificates
First aid certificates are valid for three years. A
refresher course, followed by re-examination, will
be required before re-certification.
Any person whose certificate expires must
undertake a full course of training in order to be re-
established as a first aider.
Training of first aiders for special or
unusual hazards
First aiders should have completed training in the
subjects described for first aiders, and the
following additional subjects should be included:
a) safety and hygiene in treating the
casualty
b) keeping detailed records.
In addition to the standard course, they should
usually be given specialised training related to the
particular requirements of their workplace and its
hazards.
CONTENTS FIRST PAGE

Training of appointed persons Responsibility for visitors and other

(see page 26/3)
Training courses normally last four hours and
cover the following subjects:
• communication and contents of first aid box
• resuscitation
• control of bleeding
• treatment of an unconscious casualty
HSE approval is not required for this training.
Training records
In order to be able to demonstrate compliance with
the regulations, employers must keep written
records of all training that has been given to
employees and the results of that training.
Refresher courses
Refresher courses for first aiders prior to re-
examination and re-certification should not be less
than one day in length and should include:
a) a demonstration of life saving
techniques
b) a demonstration of new techniques and
procedures
c) a revision of the subject matter of the
original first aid training course.
non-employees
The Health and Safety (First Aid) Regulations
1981 require employers to make first aid provision
for their own personnel. The Health and Safety at
Work Act 1974, however, places a general duty
upon employers in respect of their premises or
activities, and first aid arrangements should extend
to cover visitors.
Record of treatment
First aid treatment should be recorded. The use of
an accident book does not normally allow enough
detail to be gathered and an additional treatment
book may be necessary, particularly in order to
keep a record of the use of first aid materials.
Accident Reporting
All accidents causing any injury must be recorded
and, in the circumstances specified in Module 4
Part 1, Accident Reporting and Investigation,
reported to the enforcing authority.

Miscellaneous
Ambulance
The local ambulance service should be informed
about large sites and of any particularly hazardous
operations being undertaken. It is helpful to supply
a map locating the site and its entrances and,
where appropriate, the first aid room.

Induction
Induction training for employees and other
persons joining the site should include details of
the location of first aid boxes and qualified first aid
personnel.

26/7
CONTENTS FIRST PAGE

Construction Site Safety

26. Appendix A

Contents of First Aid Boxes

Item First Aid Travelling

Boxes First Aid Kits

Guidance card 1 1
Individually wrapped sterile adhesive dressings
(assorted sizes) 20 6
Sterile eye pads, with attachment 2
Individually wrapped triangular bandages 4 2
Safety pins 6 2
Medium-sized, individually wrapped, sterile, un-medicated
wound dressings (approx. 12 cm x 12 cm) 6
Large, sterile, individually wrapped, un-medicated wound
dressings (approx. 18 cm x 18 cm) 2 1
Individually wrapped, moist cleaning wipes (suggested
minimum number) 10 6
Disposable gloves (pair) 1 1

Where tap water is not readily available for eye irrigation, sterile water or sterile normal saline in sealed
disposable containers (at least 3 x 300 ml) should be provided.

Travelling first aid kits

Small travelling first aid kits are designed for use where the workforce is dispersed widely (possibly with
hazardous tools), for self-employed persons, and for employees working away from their employer’s
establishment.

Note
First aid kits purchased from major chemists or suppliers will conform to the regulations and vary in size
to cater for the numbers of people employed.

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CONTENTS
The Health and Safety (First Aid) Regulations 1981
Checklist
First aid provision
• How many employees are involved?
• How is the workforce distributed/grouped?
(Widely dispersed, etc.?)
• Are remote locations involved?
• Are shifts worked?
• What is the nature of the work?
• Does it involve special operations?
• Can particular hazards be identified, such
as falls, electric shock, dangerous
substances, etc.?
• How many first aiders are needed?
Training
• Which personnel require first aid training?
• Does the training offered meet foreseeable
needs?
• Are training records kept?
• Are individuals working in isolated locations
trained to cope with emergencies?
• Where ‘appointed persons’ are in charge,
do they understand their duties?
• Does induction training cover first aid
arrangements?
FIRST PAGE
Construction Site Safety
26. Appendix B
Equipment
• Is first aid equipment placed in locations
where it is likely to be needed?
• Does it meet foreseeable needs, special
hazards, etc.?
• Are travelling first aid kits available when
required?
• Is a first aid room needed, or available, and
suitably equipped?
• Are information signs provided?
• Are first aid boxes and kits properly
stocked and maintained?
General
• Has responsibility for first aid provision and
organisation been assigned to an
individual?
• Are there established procedures for
reviewing:
1. training and equipment needs?
2. new work processes?
3. special operations?
4. changes in work patterns, site
locations, size of labour force?
5. arrangements with sub-contractors?
26/9
CONTENTS FIRST PAGE

Construction Site Safety

26. Appendix C
The Health and Safety (First Aid) Regulations 1981
General first aid guidance for the untrained person is given in the HSE publication ‘Basic advice on first aid
at work’. The information is not meant to be used as part of any training. It is given as brief guidance for
untrained people to use in an emergency.

General First Aid Guidance for First Aid Boxes

Note: Take care not to become a casualty yourself while administering first aid. Be sure to
use protective clothing and equipment where necessary. If you are not a trained first aider,
send immediately for the nearest first aider where one is available.

Advice on treatment 2) Bleeding. If bleeding is more than

minimal, control it by direct pressure on a
If the assistance of medical or nursing personnel
pad of sterilised dressing or, if necessary,
will be required, send for a doctor or nurse (where
direct pressure with fingers or thumb on
they are employed at the workplace) or an
the bleeding point. Raising a limb if the
ambulance immediately. When an ambulance is
bleeding is sited there will help reduce
called, arrangements should be made for it to be
the flow of blood (unless the limb is
directed to the scene without delay.
fractured).
Priorities
3) Unconsciousness. Where the patient
1) Breathing. If the casualty has stopped is unconscious, care must be taken to
breathing, resuscitation must be started keep the airway open. This may be
at once before any other treatment is done by clearing the mouth and
given and should be continued until ensuring that the tongue does not block
breathing is restored or medical, the back of the throat. Where possible,
nursing or ambulance personnel take the casualty should be placed in the
over. recovery position.

Recovery position

4) Broken bones. Unless in a position

which exposes him or her to further
danger, do not attempt to move a
casualty with suspected broken
Mouth-to-mouth resuscitation bones or injured joints until the injured
parts have been supported. Secure so
that the injured parts cannot move.

26/10
CONTENTS FIRST PAGE

5) Other injuries Gassing. Move the casualty to fresh air. If

breathing has stopped, start resuscitation and
Burns and scalds. Small burns and scalds should
continue until breathing is restored or until
be treated by flushing the affected area with plenty
medical, nursing or ambulance personnel take
of clean, cool water before applying a sterilised
over. If the casualty needs to go to hospital, make
dressing or a clean towel. Where the burn is large
sure a note of the gas involved is sent with the
or deep, simply apply a sterile dressing. Do not
patient to hospital.
burst blisters or remove clothing sticking to the
burns or scalds. General
Chemical burns. Remove any contaminated Hygiene. When possible, wash your hands before
clothing which shows no sign of sticking to the treating wounds, burns or eye injuries. Take care,
skin and flush all affected parts of the body with in any event, not to contaminate the surfaces of
plenty of clean, cool water to ensure that all the the dressings.
chemical is diluted so as to be rendered harmless.
Treatment position. Casualties should be seated
Apply a sterilised dressing to exposed, damaged
or lying down while being treated.
skin and clean towels to damaged areas where the
clothing cannot be removed. Take care when Record keeping. An entry must be made in an
treating the casualty to avoid contamination. accident book for each case.
Foreign bodies in the eye. If the object cannot be Minor injuries. Casualties with minor injuries, of a
removed readily with a clean piece of moist sort they would attend to themselves if at home,
material, irrigate with clean, cool water. People with may wash their hands and apply a small sterilised
eye injuries which are more than minimal must be dressing from the container.
sent to hospital with the eye covered with a eye
pad from the first aid kit. First aid materials. Each article used from the first
aid kit should be replaced as soon as possible.
Chemical in the eye. Flush the open eye at once
with clean, cool water; continue for at least 10 to
15 minutes and, in any case of doubt, even longer.
If the contamination is more than minimal, send
the casualty to hospital.
Electric shock. Make sure that the current is
switched off. If this is impossible, free the person,
using heavy duty insulation gloves, or using
something made of rubber, dry cloth, wood or the
casualty’s own clothing (if dry). Be careful not to
touch the casualty’s skin before the current is
switched off. If breathing is failing or has stopped,
start resuscitation and continue until breathing is
restored or medical, nursing or nursing or
ambulance personnel take over.

26/11