Get Bloodborne Pathogen Exposure Report Form - Environmental Health ...

Completing the Bloodborne Pathogen Exposure Report Form is essential for documenting incidents involving potential exposure to bloodborne pathogens. This guide provides a clear and supportive overview of how to fill out the form online, ensuring that you understand each section and field.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and access it in the online editor.
2. Begin by entering your name in the designated field, followed by your employee ID, and the date of the injury. Make sure to provide accurate information as it is crucial for processing your report.
3. Indicate whether the sharp item involved in the incident was contaminated, uncontaminated, or if the status is unknown, by selecting the corresponding option.
4. Specify what the contaminated item was contaminated with by selecting 'Blood' or 'Other body fluid' and provide details if applicable.
5. Answer whether you were holding the item at the time of the exposure by selecting 'Yes' or 'No'.
6. If you were not holding the item, describe its status by selecting from the provided options, such as whether it was set aside for future use or dropped by someone else.
7. Identify the type of sharp item involved in the incident by choosing from the list provided. Be specific to ensure accurate reporting.
8. If applicable, indicate whether a needle used for lidocaine was reused, stuck you while administering, or was recapped.
9. For a scalpel, specify if it was a safety scalpel (retractable) by selecting 'Yes' or 'No'.
10. Address whether you believe the device was defective by selecting 'Yes' or 'No'. If yes, it is important to save the device for Employee Health if possible.
11. Indicate if the exposure was related to a splash by selecting 'Yes' or 'No'.
12. If applicable, specify the fluid involved in the splash by selecting from the options provided.
13. If the fluid was urine, sweat, or other specified fluids, indicate whether it was visibly bloody.
14. Indicate what type of personal protective equipment (PPE) you were wearing during the exposure event.
15. Complete the form by answering whether the fluid came in contact with intact skin, non-intact skin, eyes, mouth, or nose.
16. Finally, confirm whether someone else inadvertently splashed you by selecting 'Yes' or 'No'.
17. Once all fields are complete, save your changes. You may then download, print, or share the filled-out form as needed for your records.

Complete your Bloodborne Pathogen Exposure Report Form online today to ensure accurate documentation of your incident.