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FIRST AID BOX MEDICAL & SUPPLIES CHECKLIST

Project Name: Project Start Date:


Project Location: Project End Date:
Safety Officer On-Duty:

NUMBER OF DISTRIBUTION (PER MONTH)


Item No. Medicine Quantity
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1
2
3
4

DETAILS OF WORKERS WHO RECEIVED TREATMENT


Date Time Name Designation Complaints & Remarks Signature

NUMBER OF DISTRIBUTION (PER MONTH)


Item No. Medical Supply Quantity
Jan. Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18

Remarks:

ECO-PM-CSD-02F47
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Revision: 0

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