FIRST AID SUPPLY REQUEST
Date:
Department:
Building:
Requestor/Contact Person: Phone Ext:
INDICATE QUANTITY NEEDED:
Ammonia Capsules (4)
Antibiotic Ointment (10)
Antiseptic Towelettes (10)
Bandaids (10)
Biohazard Bags (2)
Burn Dressing (1)
Burn Treatment (10)
Eye Pads (2)
Eye Wash (1 oz.)
2 x 2 Gauze Pads (4)
4 x 4 Gauze Pads (4)
Gloves (2 pair)
Hand Sanitizer (6)
Fingertip Bandaids (10)
Ice Pack (1)
Knuckle Bandaids (10)
1” Paper Tape (1 roll)
Pocket Mask (1)
Q-Tips (5)
Roll Gauze (2)
Scissors (1)
Telfa Pads (2)
Triangular Bandage (1)
Tweezers (1)
Please return completed form to Jenny Schmidt (Jennifer.Schmidt@indianhills.edu) in Maintenance.
It is the policy of Indian Hills Community College not to discriminate on the basis of race, color, national origin, sex, disability, age (employment), sexual orientation, gender identity, creed, religion, and actual or
potential parental, family, or marital status in its programs, activities, or employment practices as required by the Iowa Code §§216.6 and 216.9, Titles VI and VII of the Civil Rights Act of 1964 (42 U.S.C. §§ 2000d
and 2000e), the Equal Pay Act of 1973 (29 U.S.C. § 206, et seq.), Title IX (Educational Amendments, 20 U.S.C §§ 1681 – 1688), Section 504 (Rehabilitation Act of 1973, 29 U.S.C. § 794), and Title II of the Americans
with Disabilities Act (42 U.S.C. § 12101, et seq.).
If you have questions or complaints related to compliance with this policy, please contact Kristen Parks, Director of Human Resources/Equity Coordinator, 525 Grandview Ave, Ottumwa, IA 52501, (641) 683-5108;
Chris Bowser, Executive Dean, Student Services, (students), (641) 683-5159; Darlas Shockley, Executive Dean, Arts & Sciences (students with disabilities), (641) 683-5174; or the U.S. Department of Education,
Citigroup Center, 500 W. Madison, Suite 1475, Chicago, IL 60661, phone number (312) 730-1560, fax (312) 730-1576.
