Public Safety Support

Bleeding Kit Resupply Request

 

 

First Hands Bleeding Control Kit Replacement Request



* = Required Fields

Form Completion Date 
Incident Date*  
Name* 
Officer Badge Number
Phone
E-mail* 
Agency Name* 
Agency Incident Report Number




Responder Category





Bleeding Control Kit Contents*




 
In what county did you use the bleeding kit?
Are you able to upload a copy of the incident report?
Did you utilize MS MED-COM during this incident?
Did you utilize the MSWIN radio system during this incident?
Did you utilize your personal cell phone during this incident?
Upload the Incident Report
*.txt,*.doc,*.docx,*.xls,*.xlsx,*.pdf
Comments or recommendations*