Stop The Bleed Training Kit Request
Please fill out this form to request a STOP THE BLEED Training Kit.  You will be required to pick-up and return the kit(s).

A course instructor may be available upon request, but we encourage eligible community partners to become trainers themselves to spread awareness and education on STOP THE BLEED throughout our region, creating a more emergency/disaster resilient community.  To become an STB instructor visit

For more information, contact Mike Gale: 435-986-2589. Or Austin Smith 435-986-2579
Sign in to Google to save your progress. Learn more
Each kit contains enough supplies to hold a 20 student course. Training Kits can also be used for exercises and drills.
Point of Contact Name
Point of Contact Phone Number
Point of Contact Email
Estimated number of students
Are you requesting a instructor or Just the Training Kit? 
Clear selection
Location of class
What date do you need the kit?
Clear form
Never submit passwords through Google Forms.
This form was created inside of Southwest Utah Public Health Department. Report Abuse