Get Report Of Potential Hiv Exposure To Law Enforcement Employees - Cdph Ca

Filling out the Report Of Potential HIV Exposure To Law Enforcement Employees can seem daunting, but with a structured approach, the process can be made easier. This guide provides step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to fill out the form correctly.

1. Press the ‘Get Form’ button to obtain the report form and open it in your online editor. This will allow you to begin entering the necessary information.
2. In the 'incident information' section, provide the location and address where the incident occurred. Ensure you include the city, county, and zip code.
3. Record the date and time of the incident, using a 24-hour clock format to maintain clarity.
4. Select the type of agency involved in the incident from the provided options. This can include law enforcement, correctional agencies, prosecutors, or courts. You may also specify other agencies if necessary.
5. Indicate the level of government of the agency, choosing from state or county.
6. Specify what the employee’s assignment was during the incident, noting their duties at that time.
7. If applicable, state whether any criminal laws were allegedly violated by the subject involved in the incident. If so, provide the specific sections that were violated.
8. Identify the bodily fluid to which the employee was exposed, choosing from options such as blood, semen, or specify another fluid.
9. Detail the type of exposure sustained by the employee. This may include needlestick, sexual exposure, skin abrasion, laceration, or blood to blood transfer, and any other type if relevant.
10. Briefly describe the circumstances surrounding the exposure. Avoid using names to maintain confidentiality. You may attach additional pages if necessary.
11. Under treatment information, indicate whether the employee received medical treatment following the incident. Specify the type of treatment provided if applicable.
12. State if the employee was tested for Hepatitis B, and provide the results if known.
13. Check if the employee required any medical interventions such as sutures, surgery, or hospitalization.
14. Mention whether the incident resulted in the employee losing work time and record the amount of time lost if applicable.
15. Continue to the HIV testing section for the subject involved, indicating whether they were tested for HIV and if counseling was provided.
16. Lastly, provide details regarding whether the employee was tested for HIV and the results. Note how long after the incident the test was conducted and if the employee has begun AZT treatments.
17. Include the name and signature of the person completing the form, along with their business telephone number and address.
18. Once all fields are filled out, save your changes. You may download, print, or share the completed form as necessary.

Complete your forms online to ensure a timely and accurate reporting process.