Health and Safety Guidance Document The Provision of First Aid
Contents
1. FAG_GUD_1 00 Page 9 of 25 a FB CANCER RESEARCH bys UK Hazard s amp how it could happen Persons at risk Current Control Measures in place Net Risk SxL S Risk Further Controls to be implemented Residual risk after controls SxL S Risk Hazard Lack of first aid provision for e Lone workers to be 2 2 6 lone workers instructed on summoning for help in How it could happen Injured an emergency when any person unable to self administer fe a injury requires other basic first aid treatment leading to ihan basic treatment untreated wounds etc e g plaster or dressing for minor cuts and grazes etc Hazard Lack of first aid provision for Appointed persons to be 2 2 6 shift workers nominated from amongst the shift working staff to How it could happen No immediate summon professional treatment available in the case of an help in an emergency injured person or a person suffering if work is of medium to from severe ill health which could high risk or staff numbers ae are high then trained lead to further complications first aid personnel either FAW or EFAW to be nominated for shift workers Hazard Working with hazardous Special first aid facilities 2 2 6 substances to be provided in these instances e g eye wash How it could happen Exposure to facilities etc First aid personnel to be FAG_GUD_1 00 Page 10 of 252. There is no mandatory requirement for CR UK to have an AED in the workplace However in cases of sudden cardiac arrest early defibrillation offers the best chances of survival and as such only first aiders with the appropriate training should use an AED The AED should also be made available where the first aid risk assessment indicates it is needed 12 Can first aiders give medicine to casualties First aid at work does not cover giving out tablets or medicines and as a rule you should avoid doing so However there are some exceptions e Aspirin in case of heart attack If someone is suffering from a heart attack the first aider may with their permission give aspirin The first aid risk assessment should identify if there is a requirement for aspirin to be kept on site for such cases No medication must be stored in a first aid kit e Epipen in Case of Anaphylactic Attack If someone suffers anaphylactic shock a first aider may treat the person using an Epipen if the casualty has been prescribed and is in possession of the Epipen the first aider has been appropriately trained in Epipen use they feel they are dealing with a life threatening situation FAG _GUD_1 00 Page 3 of 25 sR CANCER sf RESEARCH fess UK In most cases the use of an Epipen will be included in the local implementation of the first aid risk assessment so that the likely need for it to be used is known First Aid Risk Assessment Needs Assess
3. og uiti CANCER RESEARCH by UK Hazard s amp how it could happen Persons at Current Control Measures in Net Risk Further Controls to be implemented Residual risk risk place SxL S Risk after controls SxL S Risk hazardous substances may cause ill trained to deal with such health or physical injury if they situations come into contact with employees e Disposable aprons to be 1 2 3 Hazard Dealing with body fluid provided for first aid spillages e g blood vomit personnel e First aid personnel to be How it could happen Contact with trained in dealing with bodily fluids may cause ill health nine l bodily fluids included in FAW and EFAW training e Good hygiene practices to be enforced e Cleaning in relation to all area is in place and enforced after a first aid incident Hazard Dealing with multiple e First aidequipmenttobe 2 2 6 Pe provided in accordance injuries f with the requirements of How it could happen Lack of first the Health and Safety aid equipment may lead to wounds Pirat Aid Regulations quip y 1981 and the associated FAG_GUD_1 00 Page 11 of 25 SR CANCER sf RESEARCH bys UK Hazard s amp how it could happen Persons at Current Control Measures in Net Risk Further Controls to be implemented Residual risk risk place SxL S Risk after controls SxL S Risk being untreated Approved Code of
4. Medium sterile Conforming bandage min 7 5 cm width and 4 6 8 dressing min 2 m stretched length with an absorbent pad not less than 18 cm x 18 cm Large sterile Conforming bandage min 10 cm width and 2 2 dressing min 2 m stretched length with an absorbent pad not less than 12 cm x 12 cm Triangular Min 20 gsm non woven material or cotton 2 3 4 bandage not less than 90 cm x 90 cm x 127 cm Safety pins Min Length of 2 5 cm 6 12 24 Eye pad sterile Conforming bandage min 5 cm width and 2 3 4 dressing min 1 5 m stretched length or elasticated looped bandage with an oval pad not less than 7 cm x 5 cm Sterile adhesive Water resistant sterile an island design 40 60 100 dressing individually wrapped min Surface area of 7 5 cm dressing pad not less than 20 of the area Alcohol free Individually wrapped sterile min Of 80 cm2 20 30 40 moist cleansing wipes Adhesive tape Roll individually wrapped min 2 5 cm width 5 m length Nitrile Conforming to BS EN 455 1 and BS EN 6 9 12 disposable 455 2 large size 8 9 gloves Finger sterile Conforming bandage min 3 5 cm width and 2 3 4 dressing min 30 cm stretched length with a dressing pad min 3 5 cm2 FAG_GUD_1 00 Page 19 of 25 NPR CANCER pe Abis UK RESEARCH Resuscitation Includes a one way valve l 2 face shield A Foil blanket 130 cm x 210 cm 2 3 Eye wash B Sterile min Effective volume of 250mL 0 0 Burn dressing Wa
5. Practice e The provision of equipment to match the degree of risk and numbers of employees in accordance with the guidance in the HSE leaflet INDG214 rev1 First Aid at Work your questions answered Persons at risk S Staff V Visitors VO Volunteers C Contractors M Members of the public Risk S Severity L Likelihood R Risk FAG _GUD_1 00 Page 12 of 25 SR CANCER ssf RESEARCH Ftna UK Signature sheet Person s completing assessment Signature s Position Time and date completed Date for revision sses insert date here or sooner if significant changes are made to the work area or processes RECORD OF FIRST AID PROVISION You should make a record of the first aid provisions you have decided upon as a result of your first aid requirements risk assessment Decision Matrix Information First aider with a First Aid at Work FAW certificate First aider with an Emergency First Aid at Work EFAW certificate First aider with additional training specify Required to deal with specific high risk activities Appointed persons First aid equipment and facilities First aid boxes Additional equipment specify FAG_GUD_1 00 Page 13 of 25 SPR CANCER ssf RESEARCH Abis UK Travel first aid kits First aid room Note The minimum first aid provision for
6. by the British Red Cross and all records are kept centrally Appendix 5 lists the process that is in place if training of first aiders if organised through the Central H amp S team If training is being organised outside of the Central H amp S Team local procedures will need to be adopted to enable this to take place Appendix 5 can be used as a template and an amended version developed Once the process is determined and first aiders have been selected the following must take place All training must be organised through the British Red Cross BRC as CR UKs preferred supplier of First Aid at Work training BRC details are as follows o Tel 0844 412 9000 o Fax 0844 412 2866 o E mail nationalaccounts redcross org uk Once first aiders have been trained they need to contact Pearl Enuoyibo Ext 8227 who will provide training and access to the accident database Contact Pearl Enuoyibo also for first aid consumables First Aid Response It s very important that in the event of an injury where a first aider is required that this takes place in an organised way where key personnel are aware of what is required Asa guide see Appendix 6 on a process that can be followed in the event of a first aid response FAG _GUD_1 00 Page 6 of 25 ge CANCER ee a RESEARCH Sebi UK Further information Accompanying Documents The following documents provide additional information which will assist when implementing this guidance Risk Asse
7. do you need At least one First Aider trained in Emergency First Aid at Work At least one First Aider trained in EFAW or FAW depending on the type of injuries that might occur Al Teast one FAW for eve CANCER What injuries and illness have previously occurred at your location Ensure that any injuries and illness that might occur can be dealt with by the first aid personnel you provide Where first aiders are shown to be unnecessary there is still a possibility of an accident or sudden illness so you may wish to consider providing qualified first aiders Page 18 of 25 RESEARCH Have you taken account of the factors below that may affect your first aid provision Inexperienced workers or employees with disabilities or particular health problems Employees who travel a lot work remotely or work alone Employees who work shifts or out of hours Premises spread out across buildings floors Workplace remote from emergency medical services Employees working at sites occupied by other employers Planned and unplanned absences of first aiders appointed persons Members of the public who visit your premises location Appendix 3 BS 8599 Contents of Workplace First Aid Kit uiti CANCER Fi RESEARCH Ftna UK Guidance Provides brief first aid guidelines Leaflet Contents list Provides a list of first aid kit components included in kit
8. first aid room is provided it is important that local procedures are put in place to ensure that the room is properly stocked and maintained If a first aid room is required at a location consider and ensure that the rooms FAG _GUD_1 00 Page 5 of 25 osa uiti CANCER ae RESEARCH Sebi UK are large enough to hold an examination medical couch with enough space at each side for people to work a chair and any necessary additional equipment have washable surfaces and adequate heating ventilation and lighting are kept clean tidy accessible and available for use at all times when employees are at work are positioned as near as possible to a point of access for transport to hospital display a notice on the door advising of the names locations and if appropriate telephone extensions of first aiders and how to contact them In relation to typical pieces of equipment that should be available in the room consult The Regulations ACOP Paragraph 47 Training First aid training and purchasing of consumables is currently administered through the Central Health amp Safety Team for the majority of areas Other local teams from CRI and LRI as well as Events are also involved in arranging first aid training and purchasing of consumables The mandatory training that is required as per the The Regulations is for first aiders to attend a HSE Approved FAW or EFAW training course This training for CRUK is currently conducted
9. manual calibration The HeartStart has no user serviceable parts To ensure that there is always a battery available for an AED it is recommended that each battery is replaced 3 months prior to the recommended replacement date by the manufacturer A log therefore should be kept of the date a replacement battery is inserted in an AED e Periodic Checks Other than the checks recommended after each use of the HeartStart maintenance is limited to periodically checking the following Check the green Ready light If the green Ready light is not blinking see troubleshooting tips below and consult the user manual Replace any used damaged or expired supplies and accessories Check the outside of the AED if cracks or other signs of damage are seen contact the manufacturer Phillips e Troubleshooting Tips Always consult the user manual for additional advice to compliment the information listed below The HeartStart s green Ready light is the guide to knowing if the defibrillator is ready for use If the Ready light is blinking The HeartStart has passed the battery insertion self test and the last periodic self test and is therefore ready for use f the Ready light is solid The HeartStart is in use or running a self test f the Ready light is off the HeartStart is chirping the i button Is flashing A self test error has occurred there is a problem with the pads or the battery power is low Press the i button for instru
10. AL H amp S ORGANISES TRAINING as A First Aider is added to the following E mail distribution List for their building Master list of all First Aiders Fire Warden Evacuation List A First Aider information sent to HR This is required so that the annual payment to First Aiders is made Once certificate is received First Aider is sent information on how to use the BRC liaises directly with employee Central Accident Database regarding joining instructions and Employee details are placed on a master spreadsheet until their First Aid certificate is received FAG_GUD_1 00 Page 22 of 25 x CANCER I RESEARCH Abai UK Appendix 6 First aid response to an injury ill health 4 FIRST AIDER RESPONSE TO AN INJURY ILL HEALTH amp No Yes Yes No No Yes FAG_GUD_1 00 Page 23 of 25 SR CANCER ssf RESEARCH Sebi UK Appendix 7 Automated External Defibrillators AED e Routine Maintenance The HeartStart model used at CR UK is very simple to maintain The defibrillator performs a self test every day In addition a battery Insertion self test is run whenever a battery is installed in the device The AED s extensive automatic self test features eliminate the need for any
11. and maintain their confidence to perform them correctly As such CR UK endorses this FAG _GUD_1 00 Page 2 of 25 xg CANCER ae RESEARCH bys UK 9 What first aid equipment does the employer need to provide The minimum requirement at any CR UK location is to provide a suitably stocked first aid box There is no mandatory list of contents for a first aid box A CR UK s first aid risk assessment will help decide what should be included in the box See below information on First Aid Kits and the British Standard BS 8599 10 How is the requirement for First Aid Kits in relation to British Standard 8599 1 being enforced There is a British Standard BS 8599 for first aid kits According to information provided by the HSE it is not a legal requirement under the The Regulations to purchase kits that comply with this British Standard Instead the content of a first aid box is dependent on CR UKs first aid risk assessment This means that following a risk assessment CR UKs options are Within the workplace employees have access to a first aid kit where the contents complies with BS 8599 and matches the risk assessment or Within the workplace employees have access to a first aid kit where the content matches our risk assessment but does not comply with the requirements of BS 8599 See Appendix 3 for a list of contents that complies with BS 8599 11 Is there a legal requirement to have an automated external defibrillator AED
12. at Work EFAW and will give treatment relative to their qualifications FAG_GUD_1 00 Page 8 of 25 a aii CANCER RESEARCH fbi UK Hazard s amp how it could happen Persons at Current Control Measures in Net Risk Further Controls to be implemented Residual risk risk place SxL S Risk after controls SxL S Risk S IV IV Where the first aid 2 2 6 O assessment indicates that a first aid person s f should be nominated Hazard Failure to nominate a first either because of the aider or an appointed person F risk level or the number How it could happen No one i f of employees then they available to offer immediate i n are to be both treatment in the case of an injured f nominated and trained in person or a person suffering from f f accordance with the severe ill health could lead to 3 further complications or a serious Healtn and Safety Fitt injur P Aid Regulations 1981 i either in FAW or EFAW Arrangements to be made for first aid cover if the first aid person is away Hazard First aid boxes not provided S IV JV Suitable first aid boxes to 1 1 2 or contents stock low O be provided marked and readily accessible How it could happen Unable to Eirstaidiboxstocke tobe treat a wound quickly may lead to checked regularly by an further complications appointed person or first aider and should be replenished accordingly
13. ctions If the Ready light is off but the HeartStart is not chirping and the i button Is not flashing There is no battery inserted the battery is depleted or the defibrillator needs repair Insert replace battery and run the self test Provided the HeartStart passes the self test it is ready for use e Contents of AED Kit Each kit should have the following contents adult SMART pads cartridge e Pair non latex gloves 4 year battery pack e Razor red slim line carry case e Mouth to mouth shield with valve User guide manual e HeartStart Kit Pair of scissors FAG _GUD_1 00 Page 24 of 25 ine agp CANCER 2m RESEARCH Sebi UK Support and Advice For further information in relation to this standard please contact the Central Health and Safety Team Email centralhealth amp safety cancer org uk Document Control Document Owner Head of Health amp Safety Document Sponsor Director of Assurance Effective Date Ol March 2012 Version 1 0 Review Date Ol March 2015 Document Reference FAG _GUD_ 1 00 Document Amendments Date of Change Summary of Change FAG _GUD_1 00 Page 25 of 25
14. each worksite is e an appointed person to take charge of first aid arrangements e a suitably stocked first aid box e information for employees about the first aid arrangements First Aid Risk Assessment Review FAG_GUD_1 00 Page 14 of 25 sR CANCER ssf RESEARCH Abis UK Risk Estimation Severity Score Description Severity Likelihood score Score Description Probability FAG_GUD_1 00 Page 15 of 25 SR CANCER Sh RESEARCH Catastrophic risk requires immediate action Major risk requires immediate action Moderate risk requires action IMPACT SCORE Minor risk action where appropriate Insignificant risk acceptable LIKELIHOOD SCORE CR UK RESPONSE TO RISK CR UK RISK APPETITE FAG _GUD_1 00 Page 16 of 25 SAR CANCER ag RESEARCH Abi UK Risk Level FAG_GUD_1 00 Acceptability Guidance on necessary action and timescales Acceptable No further action is necessary other than to ensure that the controls are maintained Action where appropriate No additional controls are required unless they can be implemented in a reasonably practicable way in terms of time money and effort Actions to further reduce these risks are assigned low priority Arrangements should be made to monitor and ensure that the controls are maintained Requires action Consideration should be given as to whether the risks can be lowered further but the co
15. edical practitioner FAQ about First Aid 1 What is a first aider A first aider is someone who has completed a training course that is accredited by the Health and Safety Executive either a First Aid at Work course FAW or Emergency First Aid at Work course EFAW FAG_GUD_1 00 Page 1 of 25 osa oat CANCER ae RESEARCH cbis UK 2 What is an appointed person An appointed person is someone who takes charge of first aid arrangements Typically the appointed person would be in charge of looking after first aid equipment and be responsible for calling the emergency services in the event of a serious injury or illness An appointed person should not attempt to administer any first aid technique they have not been trained in To fulfil their role appointed persons do not need first aid training 3 What is First Aid at Work Training FAW The Regulations require employers to provide adequate and appropriate equipment facilities and personnel to ensure their employees receive immediate attention if they are injured or taken ill at work First aid at work training FAW is therefore the syllabus approved by the Health amp Safety Executive that must be followed to enable first aiders to be qualified to render first aid at work 4 What is Emergency First Aid at Work Training EFAW EFAW training is a 1 day Health amp Safety Executive approved course This training is aimed at organisations where the hazards are low as deter
16. ment There are no hard and fast rules on the exact number of first aiders or appointed persons required as it will depend on the circumstances of the workplace or event As an organisation CR UK is comprised of various offices and other sites spread across the UK Given this the number and type of first aid personnel required will depend on the degree of hazards encountered the number of employees in the workplace event location and other circumstances such as location of the nearest casualty unit etc In assessing the numbers of trained staff appointed to administer first aid consideration must be given to the nature of the work being undertaken and the risks faced by staff e g use of hazardous substances machinery tools etc the numbers of staff employed within the building location shift patterns and any agreed holidays staff working in isolated areas experience of staff undertaking work activities ability to take on new skills and knowledge and cope with stressful and physically demanding situations staff with disabilities physical sight hearing etc To assist in determining the assessment of first aid requirements the following processes may be followed as a guide 1 Utilise the risk assessment template Appendix 1 which covers a number of the main hazards that would need to be considered during the risk assessment process If another risk assessment process or form is used it must meet the minimum requi
17. mined by the first aid risk assessment 5 What are the key differences between FAW training and EFAW training in relation to what the first aider can do at work EFAW training enables a first aider to give emergency first aid to someone who is injured or becomes ill while at work FAW training includes EFAW and also equips the first aider to apply first aid to a range of specific injuries and illnesses 6 How many first aiders do need The number of first aiders you need will depend on an assessment of first aid needs also known as a risk assessment This should take into consideration things like the business activities you deliver your work in the number of employees and any previous history of accidents at your location 7 How often do first aiders need to re qualify First aiders need to re qualify every three years to maintain their status as a recognised first aider at work If a first aid at work certificate is held re qualification will require the first aider to complete a two day first aid at work requalification course This course will need to be completed before the existing certificate expires If an emergency first aid at work certificate is held to re qualify the first aider will need to complete the one day training every three years 8 What are annual first aid update courses The HSE strongly recommends that anyone who holds a first aid qualification should attend an annual update course to refresh their skills
18. rement of the standard 2 Read through these hazards and controls and amend accordingly where applicable 3 Add additional hazards if they apply to the operations at your location If current control measures are missing add these as further controls to be implemented 5 Once 1 3 above are completed use the Decision Process Flow Appendix 2 to determine the minimum number of first aiders or appointed persons required 6 On the risk assessment form Appendix 1 under Record of First Aid Provision at the end of the form ensure that all relevant first aid equipment are listed as required e g number of first aid boxes etc First Aid Boxes Depending on the findings of the first aid risk assessment more than one first aid box might be required on large sites First aid boxes should be easily accessible and preferably placed FAG _GUD_1 00 Page 4 of 25 oie ua CANCER ae RESEARCH Sebi UK near hand washing facilities They should only be stocked with items useful for giving first aid and should be protected from dust and damp All first aid boxes should be identified by a white cross on a green background There is no mandatory list of items to be included in a first aid container The decision on what to provide will be influenced by the findings of the first aid needs assessment As a guide where work activities involve low hazards a minimum stock of first aid items might be a leaflet giving general guidance on firs
19. sR CANCER sf RESEARCH Sebi UK Health and Safety Guidance Document The Provision of First Aid If you are reading a printed version of this document please be aware that you must check the CR UK intranet to ensure that you have the most current version of the document About this guidance document The guidance contained in this document supports the local implementation of the provision of first aid standard reflecting statutory requirements and current Approved Code of Practice guidance and best practice It is recommended that this guidance and any associated documentation is implemented however departments may choose to follow their own guidance which is in line with CR UK Health and Safety Standards Guidance document scope This document provides guidance on the provision of first aid within CR UK as required by the Health and Safety First Aid Regulations 1981 The Regulations This guidance ensures Interpretation and local application of the health amp safety standard for the provision of first aid at all CR UK locations If followed full compliance with the provision of the first aid standard What is First Aid First aid is The provision of treatment for the purpose of preserving life and minimising the consequences of injury and illness until help from a medical practitioner or nurse can be obtained The treatment of minor injuries which would otherwise not receive treatment by a qualified m
20. ssment of First Aid Requirement Form Process Flow Decision Matrix No of First Aiders Health amp Safety Standard FAS HSS 1 00 The Provision of First Aid Related CR UK Policies The policies listed below should be considered when implementing this guidance N A External Guidance Guidance listed below is provided by external organisations British Red Cross Website FAG_GUD_1 00 Page 7 of 25 og uiti CANCER RESEARCH Sebi UK Appendix Risk Assessment of First Aid Requirements Form Risk Assessment of First Aid At Work Indicate here the property or event this relates to Reference Hazard s amp how it could happen Persons at Current Control Measures in Net Risk Further Controls to be implemented Residual risk risk place SxL S Risk after controls SxL S Risk S L R S L R Hazard Failure to nominate a V IV First aiders and an 2 2 6 first aider or an appointed O appointed person to be person How it could happen No one trained to summon professional help in an emergency which may lead to further complications or serious injury nominated in accordance with the Health and Safety First Aid Regulations 1981 Appointed person to be trained to summon for professional help doctor ambulance etc in the event of an accident or case of severe ill health First aiders to be trained in either First Aid at Work FAW or in Emergency First Aid
21. sts of additional risk reduction measures should be taken into account The risk reduction measures should be implemented within an identified timescale Arrangements should be made to monitor and ensure that the controls are maintained Unacceptable Requires immediate action Substantial efforts should be made to reduce the risk to an acceptable level Risk reduction measures should be implemented urgently within an identified timescale The activity must not commence or if already started it is necessary to consider suspending or restricting the activity or to apply interim controls until risk reduction is completed Considerable resources might have to be allocated to additional controls Where the risk cannot be reduced to an acceptable level the activity can only proceed with express EB approval Unacceptable Requires immediate action Substantial improvements in risk controls are necessary so that the risk is reduced to an acceptable level The work activity must not commence or be halted until risk controls are implemented that reduce the risk to an acceptable level If it is not possible to reduce the risk the work should remain prohibited or continued after obtaining express EB approval however such approval is unlikely to be given Page 17 of 25 From your risk assessment what degree of hazard is associated with your work activity More than 50 FAG_GUD_1 00 What first aid personnel
22. t aid for example HSE s leaflet Basic advice on first aid at work 6 20 individually wrapped sterile plasters assorted sizes appropriate to the type of work hypoallergenic plasters can be provided if necessary two sterile eye pads four individually wrapped triangular bandages preferably sterile six safety pins two large sterile individually wrapped unmedicated wound dressings six medium sized individually wrapped unmedicated wound dressings and a pair of disposable gloves If your location risk assessment follows the control measures laid down in BS 8599 then as a minimum the contents of the first aid kit must have the items listed in Appendix 3 It is for each location to decide on the contents of their first aid kits The number of first aid kits required and the size of each container if using BS 8599 can be determined by using the chart in Appendix 4 Automated External Defibrillators AED On sites where AED s are in use ALL first aiders must be trained in their use and as such attend a dedicated AED training course Local arrangements must be in place to ensure that these units are maintained and that first aiders are aware of their location For additional information regarding the following in relation to AED see Appendix 7 Routine Maintenance Periodic checks Troubleshooting tips List of contents of AED kit Where to purchase supplies First Aid Rooms At locations where a
23. ter based gel soaked dressing sterile 2 2 min 100 cm surface area Shears Suitable for cutting clothing including leather l Conforming Min 7 5 cm width and 4 m stretched length 2 2 bandage A The shield is used to protect a first aider from infection from a casualty during mo resuscitation 8 This is only required in the travel first aid kit A burn dressing cools the burn injury without any pre cooling with water or any other medium FAG_GUD_1 00 The dressing does not dry out within one hour of application uth to mouth Page 20 of 25 Ae CANCER i ada Appendix 4 Decision process flow for first aid kit sizes PROCESS FLOW DECISION MATRIX FIRST AID KIT SIZES FOR BS 8599 ONLY From your risk assessment what degree of hazard is associated with How many employees are at your Number and size of first aid kit Y ion your work activity location Less than 25 1 Small Kit 232100 1 Medium Kit More than 100 1 Large Kit per 100 Employees Less than 5 1 Small Kit 1 Medium Kit More than 25 1 Large Kit per 25 Employees rryyyyy FAG_GUD_1 00 Page 21 of 25 CANCER RESEARCH UK Appendix 5 First aid process Where Central H amp S organises training FIRST AID PROCESS WHERE CENTR
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