First Aid Request Form

Section 1 – Contact Information

Full Name / Organization Name:

Contact Person (if organization):

Email Address:

Phone Number:

Location (city/town, province):

Preferred language of communication:

Section 2 – Type of Request

What type of first aid service are you requesting? (Select all that apply)
First aid trainingOn-site first aid coverage (event or workplace)Supply of first aid kits / equipmentAwareness or educational sessionPartnership / corporate service packageOther (please specify)

If “Other,” please specify:

Is this a one-time request or part of an ongoing need?
[radio* request-type use_label_element "One-time" "Ongoing / recurring"]

Please describe the purpose or context of the request:

Section 3 – Service Specifications

Expected date(s) and duration of the service:

Estimated number of people to be reached or trained:

Type of participants (e.g. staff, volunteers, students, community members):

Do you require certified IFRC training (internationally recognized)?
YesNoNot sure

Preferred delivery format:
In-personOnline / virtualBlended (both)

Do you require first aid materials or equipment?
Yes (please specify type and quantity)No

If Yes, please specify:

Section 4 – Accessibility and Inclusion

Are there participants with specific accessibility needs?

Language(s) for training or materials:

Gender or diversity considerations:

Section 5 – Logistics and Partnership Details

Location or venue of service (if applicable):

Will the venue have necessary facilities (water, shade, safety equipment, etc.)?

Are you requesting IFRC to provide logistics?

Funding arrangement:
Self-fundedCo-funded / sponsoredRequesting IFRC support

If applicable, please share partnership or CSR policy documents / links:

Section 6 – Consent and Data Use

I consent to my data being used solely for the purpose of coordinating first aid services and related reporting within the GRCS network.

I understand that anonymized data may be used for planning and accountability reporting.