Construction site first aid requirements: legal obligations, ratios and training

The legal framework

The Health and Safety (First-Aid) Regulations 1981 require employers to provide adequate and appropriate first aid equipment, facilities, and personnel. The regulations apply to all workplaces, but construction sites attract additional scrutiny because of the higher-risk nature of the work.

The regulations do not prescribe exact numbers of first aiders or specific equipment lists. Instead, they require employers to carry out a needs assessment and provide first aid arrangements that are "adequate and appropriate in the circumstances." For construction, those circumstances include risks from working at height, heavy machinery, electricity, confined spaces, and manual handling of heavy materials.

Under CDM 2015, the principal contractor has additional duties to coordinate welfare arrangements on site, which includes first aid. This does not remove each employer's individual duty, but it means the principal contractor must ensure that overall first aid provision for the site is adequate, even when multiple employers are working there.

Carrying out a needs assessment

Before determining your first aid provision, you must assess the needs of your site. HSE guidance (L74) sets out the factors to consider:

• Nature of the work: High-risk activities such as steelwork, demolition, or work with hazardous substances require more first aid provision than lower-risk finishing trades.
• Number of workers: More workers on site means more potential casualties and more first aiders needed.
• Site layout and access: A spread-out site or one with restricted access may need first aid points in multiple locations rather than a single central point.
• Distance from emergency services: Remote sites or those with difficult access for ambulances may need enhanced first aid provision to bridge the gap until paramedics arrive.
• Shift patterns: If you run multiple shifts, you need first aid cover on every shift, not just the main day shift.
• Holiday and absence cover: If your sole first aider is on leave, you still need cover. Plan for contingencies.

Document your needs assessment and review it whenever the site conditions change significantly, such as when a new high-risk phase of work begins or when worker numbers increase substantially.

How many first aiders you need

HSE does not mandate a single ratio. However, the approved code of practice provides guidance that is widely used as a benchmark:

• Fewer than 5 workers: At least one appointed person (someone designated to take charge of first aid arrangements and call emergency services) plus a suitably stocked first aid kit.
• 5 to 25 workers (higher risk): At least one person holding a current First Aid at Work (FAW) certificate.
• 25 to 50 workers (higher risk): At least two FAW-trained first aiders.
• More than 50 workers (higher risk): One additional FAW-trained first aider for every 25 workers (approximately).

These are minimums based on the needs assessment. Many principal contractors set their own standards that exceed HSE guidance. On a large multi-contractor site, you may need dedicated first aiders who are not also performing other site duties, so they can respond immediately without leaving their trade work.

On multi-contractor sites, the principal contractor should coordinate first aid provision. It is common for the PC to provide central first aid cover and for this to be documented in the construction phase plan. Subcontractors should confirm in writing that they are relying on the PC's first aid arrangements rather than providing their own, to avoid gaps or duplication.

Training requirements

There are two levels of first aid training relevant to construction sites:

• First Aid at Work (FAW): A three-day course covering a comprehensive range of first aid competencies including CPR, treating serious bleeding, fractures, burns, eye injuries, and managing an unconscious casualty. The FAW certificate is valid for three years. This is the standard required for designated first aiders on construction sites.
• Emergency First Aid at Work (EFAW): A one-day course covering the basics: CPR, dealing with an unconscious casualty, serious bleeding, and when to call for help. EFAW is suitable for appointed persons and for providing additional cover alongside FAW-trained first aiders.

Training must be delivered by an organisation approved by HSE or a recognised awarding body. Check that your training provider holds the relevant accreditation before booking.

FAW certificates expire after three years. There is no grace period. If a first aider's certificate lapses, they are no longer a qualified first aider in the eyes of the law. Track expiry dates proactively. Competency tracking tools can automate reminders so renewals do not get missed.

Equipment and facilities

Every construction site needs at least one first aid kit. HSE does not prescribe exact contents, but a construction-appropriate kit should include:

• A leaflet giving general guidance on first aid
• Individually wrapped sterile adhesive dressings (assorted sizes)
• Sterile eye pads
• Individually wrapped triangular bandages
• Safety pins
• Large sterile unmedicated wound dressings
• Medium sterile unmedicated wound dressings
• Disposable gloves
• Sterile water or saline (if no clean running water is available)

On larger sites, consider additional provisions: an automated external defibrillator (AED), burn gel, eye wash stations near areas where chemicals are used, and a stretcher or spinal board for sites with working at height risks.

First aid kits should be clearly marked, easily accessible, and checked regularly. Assign someone to inspect and restock kits on a set schedule. After any incident where first aid supplies are used, restock immediately.

If your site has a welfare facility, designate a clean, warm space as the first aid room. This should have a treatment couch, a sink with running water, and be large enough for a casualty and a first aider to work without obstruction.

Record keeping

Every first aid incident should be recorded. While the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) cover serious incidents, you should also record minor treatments. A first aid log helps you:

• Identify patterns (repeated minor injuries in the same area may point to a hazard that needs addressing)
• Demonstrate that first aid was provided promptly and appropriately
• Provide evidence for HSE inspections or civil claims
• Track the effectiveness of your risk controls

Each record should include the date and time, the name of the casualty, their employer, the nature of the injury or illness, the treatment given, and the name of the first aider who treated them.

You should also maintain records of your first aiders' training certificates, your needs assessment, first aid kit inspection logs, and any changes to your first aid arrangements. Keep these for at least the duration of the project and ideally for six years afterwards.

For a broader look at the records you need to maintain on a construction site, see our guide to construction site safety records.