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MSR

Medical Supply Request

Select needed supplies from the list below.

In need of a supply not on this list?

Complete a Specialty Medical Supply Request

Medical Bag Checklist

Name of Requester

Phone

Campus

R Outside Pocket: Vitals | Please select any needed supply.

Stethoscope

BP Cuff

Pulse Oximeter

Thermo Scan

L Outside Pocket: Emergency Airway | Please select any needed supply.

EpiPen + EpiPen Jr.

Nasopharyngeal Airway Kit (4) + Gel

Oropharyngeal Airway Kit (5)

L Inside Pocket: Acute Injury | Please select any needed supply.

Simple Saline Solution (2)

Instant Cold Packs (8)

Top Inside Pocket: Burn and Trauma | Please select any needed supply.

60 x 90” Burn Sheets (1)

8 x 10 Absorbent Pad

The “H” Bandage (1)

Soft Shell Splints (2)

12 x 30 Multi Trauma Dressing (1)

4 x 4 Gauze Sponges (20)

Comprehensive Combat Dressing (1)

Gloves (10)

Medical Scissors (1)

New Option

Main Compartment: Top L to R | Please select any needed supply.

3” Coban (2)

Triangular Bandage (2)

Assorted Gloves

4 x 4 Gauze Sponges (2)

5 x 9 ABD Pads (7)

3 x 3 ABD Pads (6)

Lg. Band-Aids

Oval Eye Band-Aid (2)

Petroleum Gauze Strip (_)

Main Compartment: Top L to R | Please select any needed supply.

3” Coban (2)

Conforming Gauze (_)

Scissors (1)

Tweezers (1)

Med Tape (2)

Pens (2)

Assorted Ace Bandages (4)

Inner Compartment: Bottom L to R | Please select any needed supply.

4 x 4 Gauze

2 x 4 and 3” Conforming Gauze

Reg. Band-Aids

4.5 x 3.1 Kendall Gauze

Quick Clot Combat Gauze

Gloves

Head Lamp (1)

CPR Mask (1)

Tactical Tunicate (4)

Inside Top Flap: Miscellaneous | Please select any needed supply.

Pen Light (1)

Clipboard with forms

If you are human, leave this field blank.

In need of a supply not on this list?

Complete a Specialty Medical Supply Request

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