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Get Exposure Incident Report Form Template

BBP-1 EXPOSURE INCIDENT REPORT FORM Employee Name UIN Department Date Supervisor Name please print Description of Incident be specific and include date approximate time and place Use back of sheet if needed Immediate Actions Taken Source of Blood or OPIMs include name of source individual if known Personal Protective Equipment Worn Hepatitis B Vaccination Status declined vaccine complete 1st shot 2nd shot Employee Signature Date.

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  • hepatitis
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  • Vaccine
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