Annual Usage Report for Emergency School Kits, Office of Emergency Medical Services

*Required Fields
1. Was the kit utilized in the past year? yes No
If yes, how many times:

2. Was the kit used during any event? yes No
If yes, give an example of what type of event it was used for:


3. What was used the most?


4. What was used the least?


5. What would you recommend removing in future kits?


6. What would you recommend including in future kits?


7. Was the kit transported off property? yes No
If yes, where was the kit taken to and for what purpose?


8. What was your cost to replace equipment used?


*Name of School District:
* Location of kit:
* Name of Person Submitting this report:
* Contact Phone Number: - - Ext:
E-mail Address:

Comments

Department of Health and Senior Services P. O. Box 360, Trenton, NJ 08625-0360 Phone: (609) 292-7837 Toll-free in NJ: 1-800-367-6543 Our Locations
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Last Modified: Monday, 31-Dec-07 12:49:20