HFORM14: First Aid Needs Assessment¶
Form Reference: HFORM14 Version: 1.0 Classification: CRGI Information Form Owner: Sean Ashton, Operations Manager Purpose: Assess workplace first aid requirements per Health and Safety (First-Aid) Regulations 1981 and HPOL17. Determine adequate first aid personnel, equipment, and arrangements to provide prompt and appropriate care for injured persons.
Document Control¶
| Version | Date | Author | Changes |
|---|---|---|---|
| 1.0 | 10/03/2026 | Sean Ashton | Initial creation |
1. Assessment Details¶
| Field | Details |
|---|---|
| Assessment Reference | FA-____-______ |
| Assessment Date | ________________ |
| Assessor Name & Competency | ________________ |
| Location/Workplace | ________________ |
| Location Type | ☐ Home office ☐ Client site ☐ Shared workspace ☐ CRGI office |
| Assessment Type | ☐ Initial assessment ☐ Periodic review ☐ Following change |
| Next Review Date | ________________ |
| Review Frequency | ☐ Annually ☐ Every 2 years ☐ Following significant changes |
2. Workplace Profile¶
| Field | Details |
|---|---|
| Type of workplace | ☐ Home office ☐ Client site office ☐ Shared workspace ☐ CRGI office |
| Total number of staff | ____ (at location) |
| Staff working pattern | ☐ Full-time ☐ Part-time ☐ Shift working ☐ Flexible ☐ Remote |
| Nature of work | ☐ Engineering design ☐ Consultancy ☐ Project management ☐ Administrative ☐ Mixed |
| Specific hazards present | ☐ Chemical ☐ Noise ☐ Height ☐ Electrical ☐ None ☐ Other: ________ |
| Remote/home worker provisions | ☐ Yes (_____ home workers) ☐ No |
| Sites managed | ____ (if multiple locations) |
3. Risk Level Assessment¶
Based on workplace type and hazards, assess first aid risk level:
| Risk Factor | Level | Details |
|---|---|---|
| Hazard exposure | ☐ Low ☐ Med ☐ High | ________________ |
| Staff numbers | ☐ <50 ☐ 50-100 ☐ >100 | Total: ____ |
| Distance to nearest hospital | ☐ <30 mins ☐ 30-60 mins ☐ >60 mins | Distance: ____ km |
| Remote/isolated working | ☐ No ☐ Occasional ☐ Regular | Details: ______________ |
| Historical incident rate | ☐ No incidents ☐ 1-2 incidents ☐ >2 incidents | Period: ______________ |
Overall First Aid Risk Level:
☐ Low Risk – Low hazards, small workforce, good hospital access, minimal incidents - Recommended minimum: First aid kit + designated person trained in first aid awareness
☐ Medium Risk – Some hazards, moderate workforce, reasonable hospital access, occasional incidents - Recommended minimum: First aider (HSE Appointed Person level) + stocked first aid kit
☐ High Risk – Significant hazards, large workforce, poor hospital access, or isolated location - Recommended minimum: One or more fully trained first aiders, possibly backup provision
Agreed Risk Level: ☐ Low ☐ Medium ☐ High
4. First Aid Personnel Assessment¶
Current First Aid Provision¶
| Name | Qualification | Qualification Expiry | Level | Location | Availability | Status |
|---|---|---|---|---|---|---|
| ________________ | ☐ HSE FA ☐ EFAW ☐ Appointed ☐ Other |
__________ | ☐ Full ☐ Refresh due |
________________ | ☐ Full-time ☐ Part-time |
☐ Active ☐ Away |
| ________________ | ☐ HSE FA ☐ EFAW ☐ Appointed ☐ Other |
__________ | ☐ Full ☐ Refresh due |
________________ | ☐ Full-time ☐ Part-time |
☐ Active ☐ Away |
| ________________ | ☐ HSE FA ☐ EFAW ☐ Appointed ☐ Other |
__________ | ☐ Full ☐ Refresh due |
________________ | ☐ Full-time ☐ Part-time |
☐ Active ☐ Away |
Total first aiders: ____
Refresher training due for: ________ (names/dates)
Adequacy of First Aid Personnel¶
| Assessment | Yes | No | Comments |
|---|---|---|---|
| Sufficient trained personnel for workforce size | ☐ | ☐ | ________________ |
| Adequate cover during holidays/absences | ☐ | ☐ | ________________ |
| Adequate cover during shift working | ☐ | ☐ | ________________ |
| Training current and in-date | ☐ | ☐ | ________________ |
| First aiders known to staff | ☐ | ☐ | ________________ |
| First aid cover at remote sites | ☐ | ☐ | ________________ |
Training needs identified: ☐ Yes ☐ No
If yes, specify: ________________________________________________________________
| Person | Training Type | Target Date | Priority |
|---|---|---|---|
| ________________ | ☐ HSE FA ☐ EFAW ☐ Refresh |
__________ | ☐ High ☐ Med ☐ Low |
| ________________ | ☐ HSE FA ☐ EFAW ☐ Refresh |
__________ | ☐ High ☐ Med ☐ Low |
5. First Aid Equipment Audit¶
First Aid Kit Assessment¶
Location: ________________ Last checked: __________ Responsible person: ________________
| Item | Qty Required | Qty Actual | Condition | Expiry Status | Adequate |
|---|---|---|---|---|---|
| Sterile dressings (assorted) | ____ | ____ | ☐ Good ☐ Poor | ☐ Current ☐ Expired | ☐ Y ☐ N |
| Sterile eye pads | ____ | ____ | ☐ Good ☐ Poor | ☐ Current ☐ Expired | ☐ Y ☐ N |
| Triangular bandages | ____ | ____ | ☐ Good ☐ Poor | ☐ Current ☐ Expired | ☐ Y ☐ N |
| Elastic bandages | ____ | ____ | ☐ Good ☐ Poor | ☐ Current ☐ Expired | ☐ Y ☐ N |
| Non-adherent dressings | ____ | ____ | ☐ Good ☐ Poor | ☐ Current ☐ Expired | ☐ Y ☐ N |
| Gauze swabs | ____ | ____ | ☐ Good ☐ Poor | ☐ Current ☐ Expired | ☐ Y ☐ N |
| Cotton wool pads | ____ | ____ | ☐ Good ☐ Poor | ☐ Current ☐ Expired | ☐ Y ☐ N |
| Antiseptic wipes | ____ | ____ | ☐ Good ☐ Poor | ☐ Current ☐ Expired | ☐ Y ☐ N |
| Sterile gloves | ____ | ____ | ☐ Good ☐ Poor | ☐ Current ☐ Expired | ☐ Y ☐ N |
| Tweezers | ____ | ____ | ☐ Good ☐ Poor | ☐ Current ☐ Expired | ☐ Y ☐ N |
| CPR barrier/face shield | ____ | ____ | ☐ Good ☐ Poor | ☐ Current ☐ Expired | ☐ Y ☐ N |
| Saline eyewash | ____ | ____ | ☐ Good ☐ Poor | ☐ Current ☐ Expired | ☐ Y ☐ N |
| Triangular sling | ____ | ____ | ☐ Good ☐ Poor | ☐ Current ☐ Expired | ☐ Y ☐ N |
| Scissors | ____ | ____ | ☐ Good ☐ Poor | ☐ Current ☐ Expired | ☐ Y ☐ N |
| Plasters (assorted) | ____ | ____ | ☐ Good ☐ Poor | ☐ Current ☐ Expired | ☐ Y ☐ N |
First aid kit overall status: ☐ Adequate ☐ Requires restocking ☐ Requires replacement
Burns Kit¶
Location: ________________ Present: ☐ Yes ☐ No
| Item | Qty | Condition | Expiry | Adequate |
|---|---|---|---|---|
| Sterile burns dressing | ____ | ☐ Good ☐ Poor | ☐ Current ☐ Exp | ☐ Y ☐ N |
| Sterile non-adherent pads | ____ | ☐ Good ☐ Poor | ☐ Current ☐ Exp | ☐ Y ☐ N |
| Gauze pads | ____ | ☐ Good ☐ Poor | ☐ Current ☐ Exp | ☐ Y ☐ N |
| Elastic bandages | ____ | ☐ Good ☐ Poor | ☐ Current ☐ Exp | ☐ Y ☐ N |
Status: ☐ Adequate ☐ Not required ☐ Needs addition
Eye Wash Station/Eyewash Bottle¶
Present: ☐ Yes – Location: ________________ ☐ No ☐ Not applicable
| Item | Details |
|---|---|
| Type | ☐ Eyewash bottle ☐ Eyewash station ☐ Both |
| Expiry date | __________ |
| Location known to staff | ☐ Yes ☐ No – signage required |
| Adequate supply | ☐ Yes ☐ No |
| Condition | ☐ Good ☐ Expired – Replacement: __________ |
Automated External Defibrillator (AED)¶
Present: ☐ Yes – Location: ________________ ☐ No ☐ Planned
| Item | Details |
|---|---|
| Model | ________________ |
| Maintenance status | ☐ Current ☐ Service overdue – Date: __________ |
| Battery check date | __________ |
| Pads expiry date | __________ |
| Training for staff | ☐ Yes – % trained: ____ ☐ No |
| Signage in place | ☐ Yes ☐ No |
| Location known to staff | ☐ Yes ☐ No |
Emergency Blanket¶
Present: ☐ Yes – Qty: ____ ☐ No
Condition: ☐ Good ☐ Expired ☐ Damaged – Action: ________________________________________________________________
6. First Aid Arrangements¶
Accessing First Aid Help¶
| Item | Details |
|---|---|
| Procedure for accessing first aid | ☐ Documented – Reference: _______ ☐ Needs documentation |
| Location of first aider information | ________________ |
| Procedure for contacting first aider | ☐ Phone number posted ☐ Name list displayed ☐ Induction information |
| Procedure for remote/home workers | ☐ Documented ☐ Needs documentation |
| Out-of-hours first aid | ☐ Arranged: ________________ ☐ N/A ☐ Needs arrangement |
Emergency Services Contact¶
| Service | Number | Details |
|---|---|---|
| Emergency (Police, Fire, Ambulance) | 999 | Call immediately for serious injuries |
| Local A&E Department | ________________ | Address: ________________ |
| Out-of-hours medical | ________________ | ________________ |
| Occupational Health | ________________ | Tel: ________________ |
| Poison Control | 111 | For ingestion cases |
Emergency contact posters displayed: ☐ Yes – Locations: ________________ ☐ No – Required
Incident Reporting¶
Procedure for reporting first aid incidents: ☐ Documented – Reference: ________________ ☐ Needs documentation
Recording location (HREG03): ________________
Manager notified: ☐ Automatic ☐ Manual ☐ Needs procedure
7. Training Requirements¶
Current First Aid Training Status¶
| Staff Member | HSE FA Cert | Expiry | EFAW Cert | Expiry | Refresher Due |
|---|---|---|---|---|---|
| ________________ | ☐ Yes ☐ No | __________ | ☐ Yes ☐ No | __________ | ☐ Yes ☐ No |
| ________________ | ☐ Yes ☐ No | __________ | ☐ Yes ☐ No | __________ | ☐ Yes ☐ No |
Training Plan¶
| Staff Requiring Training | Training Type | Target Date | Provider | Estimated Cost |
|---|---|---|---|---|
| ________________ | ☐ HSE FA ☐ EFAW ☐ Refresh |
__________ | ________________ | £_____ |
| ________________ | ☐ HSE FA ☐ EFAW ☐ Refresh |
__________ | ________________ | £_____ |
Annual training budget allocation: £_____ Budget balance: £_____
8. First Aid Awareness for All Staff¶
Induction first aid awareness training:
☐ Documented – Reference: ________________ ☐ Needs development
Topics covered (if documented):
☐ Location of first aid facilities ☐ Emergency contact procedures ☐ Basic first aid principles ☐ CPR awareness (link to AED) ☐ When to call emergency services
Refresher schedule: ☐ Annual ☐ Every 2 years ☐ As needed
9. Home Worker Provisions (if applicable)¶
Remote working staff: ☐ Yes – Number: ____ ☐ No
Home worker first aid provisions:
| Provision | Status | Details |
|---|---|---|
| First aid kit provided | ☐ Y ☐ N | Location: ________________ |
| Kit contents checked | ☐ Y ☐ N | Date: __________ |
| First aid information provided | ☐ Y ☐ N | Reference: ________________ |
| Emergency contact procedure | ☐ Y ☐ N | Reference: ________________ |
| Risk assessment completed | ☐ Y ☐ N | Reference: RA003 |
| Support from first aider available | ☐ Y ☐ N | Method: ________________ |
Home worker support needs: ☐ Additional provision needed ☐ Current provision adequate
10. Actions Required¶
| Issue Identified | Action | Owner | Target Date | Priority |
|---|---|---|---|---|
| ________________ | ________________ | ________________ | __________ | ☐ H ☐ M ☐ L |
| ________________ | ________________ | ________________ | __________ | ☐ H ☐ M ☐ L |
| ________________ | ________________ | ________________ | __________ | ☐ H ☐ M ☐ L |
11. Assessment Sign-Off¶
| Role | Name | Signature | Date |
|---|---|---|---|
| Completed By | |||
| Reviewed By | |||
| Approved By |
12. Supporting Documentation¶
Attached to assessment:
☐ First aid kit inventory & check list ☐ First aider training certificates (copies) ☐ AED maintenance records ☐ Eyewash/emergency equipment check sheets ☐ Emergency contact information ☐ First aid procedure documentation ☐ Training records & attendance ☐ Risk assessment references (HREG03)
13. Compliance Statement¶
I confirm that this first aid needs assessment has been completed in accordance with the Health and Safety (First-Aid) Regulations 1981 and HSE guidance. First aid arrangements are adequate to provide prompt and appropriate response to injuries and medical emergencies.
Assessment validity: This assessment remains valid for ☐ 1 year ☐ 2 years until reviewed or significant change occurs.
RETENTION: 3 years STORAGE: Secure SharePoint – /HSQEMS/FirstAid/ + HREG03 Incident Register ACCESS: Operations Manager, First Aiders, Health & Safety, Management CLASSIFICATION: CRGI Information
Related Documents: HPOL17, HPROC16, HREG03, Emergency Procedures
END OF FORM