First Aid Assessment Template

Business Name: [Insert Business Name] Trading Name: [Insert Trading Name] ABN: [Insert ABN] Address of Workplace: [Insert Full Address] Date of Assessment: [DD/MM/YYYY] Assessment Review Date: [DD/MM/YYYY] Name of Assessor: [Insert Name] Position: [Insert Position]

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1. Workplace Profile

Industry: [e.g. Construction, Retail, Hospitality] Number of Workers: [Insert Number] Number of Visitors/Public per day: [Insert Number] Work Hours: [e.g. Mon-Fri 8am-5pm] Shift Work: [Yes/No] Remote or Isolated Work: [Yes/No]

2. Hazard Identification

List the specific hazards present in the workplace.

Hazard	Risk Level (Low/Med/High)	Potential Injury Required
[e.g. Use of power tools]	[e.g. High]	[e.g. Cuts, Amputations]
[e.g. Working at heights]	[e.g. High]	[e.g. Fractures, Head Injury]
[e.g. Hazardous chemicals]	[e.g. Medium]	[e.g. Chemical burns, Inhalation]
[e.g. Manual handling]	[e.g. Medium]	[e.g. Sprains, Strains]
[e.g. Electrical work]	[e.g. High]	[e.g. Shock, Burns]

3. First Aid Risk Determination

Based on the hazards above, determine the overall risk level.

Overall Workplace Risk Level: [Low / High]

Justification: [Explain why the workplace is low or high risk based on the Code of Practice]

4. First Aider Requirements

Current Number of Trained First Aiders: [Insert Number]

Calculated Required Number: [Insert Number]

(Reference: Low risk = 1:50 workers, High risk = 1:25 workers)

Action Required: [e.g. Appoint 2 additional staff to complete HLTAID011 training]

5. First Aid Kits

Location of Kit 1: [Insert Location] Type of Kit: [Low Risk / High Risk / Remote] Service Date: [DD/MM/YYYY]

Location of Kit 2 (if applicable): [Insert Location] Type of Kit: [Low Risk / High Risk / Remote] Service Date: [DD/MM/YYYY]

Additional Specialised Equipment Required: [e.g. Eye wash station, Burn treatment gel, Spine board]

6. First Aid Facilities

Is a First Aid Room required? [Yes/No]

If Yes, Location: [Insert Location]

Hygiene Facilities: [e.g. Access to running water, soap, paper towels]

7. Access to Emergency Services

Ambulance response time estimate: [Insert minutes]

Emergency contact procedure: [Brief description of how to call 000]

Do emergency services require special access instructions? [e.g. Gate codes, security clearance]

8. Defibrillator (AED)

Is an AED on site? [Yes/No]

Location: [Insert Location]

9. Consultation

Names of workers consulted: [List Names]

Date of Consultation: [DD/MM/YYYY]

10. Sign Off

I confirm this assessment accurately reflects the first aid needs of this workplace.

Signature: __________________________ Date: __________________________

Manager/PCBU Signature: __________________________ Date: __________________________