Get What Form Should Be Completed In The Event Of A Contaminated Sharps Injury - Dshs State Tx

This guide provides clear, step-by-step instructions on completing the Contaminated Sharps Injury Reporting Form required by the Texas Department of State Health Services. It is essential for facilities to accurately report injuries involving contaminated sharps, ensuring both compliance and safety.

Follow the steps to fill out the form accurately online.

1. Press the ‘Get Form’ button to access the form and open it in the document management system.
2. Enter the facility name where the injury occurred. Include the street address, city, county, and zip code.
3. If the reporter's address is different from the facility's address, provide the street address of the reporter.
4. Fill in the date of the report, including the reporter’s name, telephone number, and email.
5. Indicate the time of the injury and the date of the injury.
6. Select the type and brand of the sharp involved by checking the appropriate box from the list provided.
7. Choose the original intended use of the sharp from the options given, marking the relevant box.
8. Describe when and how the injury occurred, selecting from the multiple-choice options regarding circumstances.
9. Answer whether the sharp device has engineered sharps injury protection, indicating if the protective mechanism was activated.
10. Indicate if the injured person was wearing gloves and whether they had completed a hepatitis B vaccination series.
11. Confirm the availability of a sharps container for disposal and whether it allowed visibility into the disposal level.
12. Note whether the injured person had received training on the exposure control plan in the past year.
13. Select the body part that was injured by marking the appropriate box.
14. Choose the job classification of the injured person from the predefined list by checking the relevant box.
15. Specify the employment status of the injured person by selecting the appropriate option.
16. Indicate the location or facility where the sharps injury occurred by checking the relevant box.
17. Identify the work area where the injury took place by marking the correct box.
18. Add any relevant comments in the provided section, if applicable.
19. Once all fields are completed, review the information for accuracy, then save the changes, download the form, or share it as necessary.

Complete your documents online to ensure health and safety compliance.