Get University Of Memphis Incident Report Exposure To Blood Or Other Potentially Infectious Materials 2016-2025

Filing an incident report for exposure to blood or other potentially infectious materials is a crucial step in ensuring safety and compliance at the University of Memphis. This guide provides clear and comprehensive instructions on how to fill out the online form accurately and efficiently.

Follow the steps to successfully complete the online incident report form.

1. Click the ‘Get Form’ button to access the incident report form and open it in the online editor.
2. Begin by filling in your last name and first name in the designated fields to identify yourself.
3. Enter your University Identification Number (UID) to help link the report to your records.
4. Provide your home phone and work phone numbers, ensuring you can be contacted if further information is needed.
5. Indicate your job title and department to clarify your position within the university.
6. Fill in your supervisor's name and title to facilitate the reporting process and accountability.
7. Record the date and time of the exposure incident, noting whether it occurred in the A.M. or P.M.
8. Specify if protective equipment was in use during the incident by selecting 'Yes' or 'No.'
9. In the section regarding the source of exposure, provide details about the device used, type, and brand, if applicable.
10. Indicate the HBV and HIV status of the source, choosing from positive, negative, or unknown.
11. Explain how the exposure occurred, providing as much detail as possible for clarity.
12. Describe the immediate actions taken following the exposure to demonstrate compliance with safety protocols.
13. Include any additional comments that may be relevant to the incident report.
14. Indicate to whom the incident was reported for proper documentation.
15. Specify if a physician referral has been scheduled by selecting either 'Yes' or 'No.'
16. Review the agreement statement regarding examination and treatment options and select the appropriate acknowledgment.
17. Sign and date the form, ensuring both employee and supervisor sign where required.
18. Confirm that your supervisor will complete and attach the required 'First Report of Injury or Illness' form as per university procedure.
19. Once all sections are completed, you can submit the form electronically to EH&S by clicking 'Submit to EH&S.'
20. Lastly, save any changes, download a copy for your records, or print the completed form if needed.

Complete your incident report online today to ensure your safety and compliance.