First Aid Assessment Form Employer’s Name: Location Assessed: Shift Name and/or Time: Assessment Date or Date of Review: Workers Consulted: Joint committee participated Date(s) of Consultation(s) with Joint Committee and/or Workers: Documented By: Contact Number (Optional): Minimum First Aid Determine the number of workers per shift Count every worker at your workplace or worksite or on this shift, including dispatched workers, managers, and supervisors. Maximum Number of Workers at this Location or on this Shift: Determine your hazard rating Is this a separate administrative location? Yes No If yes, your hazard rating is Low (check on “Low”) If no, refer to the Workplace hazard ratings document (click the link or scan the QR code) to find the hazard rating assigned to your classification unit (CU). What is your CU? What is the hazard rating assigned to your CU? Are work activities at this location typical of your CU? Yes No, work activities are more consistent with activities of another CU with a higher hazard rating No, this is a multiple employer workplace where the work is phased Alternative CU Check on the hazard rating assigned to your CU Check on the hazard rating assigned to the alternative CU Hazard rating LowModerateHigh Determine if your workplace is remote and/or less accessible Determine if your workplace is remote. How long does it typically take to drive from your workplace to the nearest ambulance station operated by British Columbia Emergency Health Services (BCEHS)? If 30 minutes or less to BCEHS station check Remote If more than 30 minutes check Not Remote Time to BCEHS station check Remote Not RemoteRemote Determine if your workplace is less accessible. Are workers working in any of the following areas? Group 1 Backcountry areas only accessible by all-terrain vehicle (ATV), snowmobile, or similar meansAreas where the only means of access involves steep or slippery slopes or embankments (without walkways)Private, industrial, or resource roads that cannot be made accessible to BCEHSAreas with rough or complex terrainAreas where there is a significant risk of avalanche, landslide, flood, or other natural hazardsA ferry your workplace is less accessible. check on Workplace is less accessible Group 2 Confined spaces or areas where there is a risk of entrapmentUnderground work areasExcavationsAreas that are only accessible by ladders, scaffold, or temporary work platformsWork areas at high angles, or where an unguarded fall hazard existsAreas where a drowning hazard exists (work on or over water)Areas requiring specialized personal protective equipment (PPE) or areas where hazardous atmospheres may existOther hazardous areas not accessible to BCEHS attendants Describe If you checked one or more of the boxes in Group 2, your workplace is less accessible check the option below, Otherwise all the following conditions are met: Workplace is not remoteNo boxes in Group 1 are selectedAlternative provisions are in place to safely rescue workers from the hazardous area to an area accessible to BCEHS Workplace is less accessibleWorkplace is not less accessible Determine your workplace class Based on your answers about remoteness and accessibility, check off the box below for your workplace class. Refer to the Minimum first aid requirements document (click the link or scan the QR code) for tables that list the minimum requirements for your class. Remote Less accessible Workplace class Schedule 3-A table Schedule 3-A tables No No Class 1 Table 3-1 Yes No Class 2 Table 3-2 No Yes Class 3 Table 3-3 Yes Yes Class 4 Table 3-4 Document your minimum first aid requirements Based on the maximum number of workers at your workplace, your hazard rating, and your workplace class, consult the applicable Schedule 3-A table to determine your minimum first aid requirements and document below. Refer to the First aid equipment, supplies, and facilities document (click the link or scan the QR code) to see what equipment your first aid kit(s) and first aid facilities must include. First aid kit Personal Basic Intermediate Advanced First aid facilities None Dressing station First aid room First aid attendant(s) None Basic:1 or2 Intermediate:1 or2 or3 Advanced:1 or2 Transport endorsement Emergency transportation For 1 worker For 2 worker None Describe type of emergency transportation (if applicable) Additional first aid Consider the following additional factors that may affect your ability to promptly provide an injured worker first aid or transportation to medical treatment: Risks and hazards unique to the workplace Risks and hazards not typical of your CU Types of injuries that have previously occurred at the workplace or similar workplaces Barriers that could limit or delay a worker’s access to first aid Equipment that may be necessary to safely rescue a worker from less accessible areas Known barriers that may affect BCEHS response time or time to transport to hospital Document first aid services provided at this workplace Based on the minimum first aid services required by Schedule 3-A and your consideration of the additional factors above, document the first aid services provided at this workplace. If services provided are different than the minimum required, document below. If services provided are different than the minimum required, document below. Supplemental first aid supplies or equipment First aid facilities (types of facilities) First aid attendant(s) (number of attendants and certification level for each) Per shift Total at this workplace Emergency transportation (type of transport and number of workers that can be transported at the same time) Next steps Your assessment must be updated annually and available at the workplace you have assessed so that workers, supervisors, and WorkSafeBC prevention officers can validate its accuracy and confirm availability of the required first aid.