Wufoo
Loyola Club Sports - EAP Bag Supply Form
Please fill out the following form with the quantities of items needed to replenish your team’s Emergency Action Bag, First Aid Kit and/or Small Biohazard Kit.
The number in parenthesis is the required minimum that should be in each kit. Items should be requested prior to depletion, if possible.
Date
*
MM
/
DD
/
YYYY
Officer/Coach Name
*
First
Last
Club
*
Email
*
Check All That Apply
Wool Blanket (1)
Compact Emergency Blankets (8)
Old Towels (2)
Waterproof Tape (1 roll)
Scissors (1)
Vinyl Exam Gloves (2)
Tweezers (1)
Antibiotic Ointment (4 packets)
Flex/Conform/Stretch Gauze Bandages (1)
Insect Sting Swabs (5)
Eye Wash Bottles (2)
Eye Cups (2)
Cold Pack (4)
Finger Guard (1)
3/4" or 1" Plastic Strips (10)
2" ACE Bandage (2)
4" ACE Bandage (2)
2" Jumbo Plastic Strips (2)
2x2 Gauze Sponges (2)
3x3 Guaze Sponges (2)
Antiseptic Wipes (6)
Eye Pads (2)
Burn Cream (6 packages)
Clamshell CPR Mask (1)
Biohazard Bags (5)
Disposable Wipes (13)
Small Gloves (5 pairs)
Large Gloves (7 pairs)
Our EAP bag is fully stocked, no supplies are needed!
Quantities Needed:
Required for ALL checked supplies.
Wool Blanket
Compact Emergency Blankets
Old Towels
Waterproof Tape
Scissors
Vinyl Exam Gloves
Tweezers
Antibiotic Ointment
Flex/Conform/Stretch Gauze Bandages
Insect Sting Swabs
Eye Wash Bottles
Eye Cups
Cold Packs
Finger Guard
3/4" or 1" Plastic Strips
2" ACE Bandage
4" ACE Bandage
2" Jumbo Plastic Strips
2x2 Gauze Sponges
3x3 Gauze Sponges
Antiseptic Wipes
Eye Pads
Burn Cream
Clamshell CPR Mask
Biohazard Bags
Disposable Wipes
Small Gloves
Large Gloves
Additional Notes/Questions
Do Not Fill This Out