Bleeding Control Kit Application

Bleeding Control Kit Application

If you are interested in applying for bleeding control kits for your facility, please fill out the current form to see if you qualify. Please note our priority is to the School Response Program who have already completed STOP THE BLEED training.

Eligible organizations and requirements can be reviewed on our website: https://trauma.georgia.gov/stop-the-bleed

Questions? Please email Crystal.Shelnutt@gtc.ga.gov

Type of Requesting Organization:*

Select

Has your organization already received a bleeding control kit allotment from our program?*

The Georgia Trauma Commission currently supports a one-time allotment of kits. Should you need additional kits, please visit our website for purchase instructions.

Yes

Has your facility completed a STOP THE BLEED training course?*

All applying organizations must have at least 10 staff trained prior to kit distribution.

Yes

Please enter the last date of your facility's Stop the Bleed Training.*

The estimated date is acceptable.

Who is the designated Stop the Bleed instructor for your facility?

Kit Allocation Parameters

The Georgia Trauma Commission has allowed maximum kit allotment parameters based on the organization type.

Download approved kit parameters here

Please provide the following information so our RTAC Coordinators can calculate your kit allotment.

School Type*

K-12 Public School

Other Public Institution

How many schools are you applying for?*

How many school buses are you applying for?*

How many buildings are part of your organization*

Average accepted.

How many floors within each building?*

Average accepted.

Is your agency considered Rural or Urban?*

Rural

Urban

Organization Details

Name of Organization*

Organization Address*

City*

Zip Code*

Organization County*

Select

Organization Point of Contact Information

First Name*

Last Name*

Title*

Email*

Phone*

Phone

Are you able to pick up kits at a designated location?*

Yes

Comments

Organization Does Not Qualify

We're sorry, your organization does not qualify for our kit distribution at this time.

The Georgia Trauma Commission offers a one-time kit allocation to the following organizations:

• Public K-12 Schools

• Public K-12 School Buses

• Other Public Education Institutions

• Law Enforcement

• Government Agencies

Organizations must be trained in Stop the Bleed. RTAC Coordinators may assist in setting up a training at your facility. Please complete the following survey to request training: https://www.surveymonkey.com/r/STBcourserequestform

All organizations are welcome to purchase additional kits with our locked rate. Please find purchase instructions here: https://trauma.georgia.gov/STB/purchase-bleeding-control-kit

If you have any additional questions, please contact us at gtcbusinessops@gtc.ga.gov

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