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Get Wv Needlestick Reporting Contact Information Form 2017-2025
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How to fill out the WV Needlestick Reporting Contact Information Form online
Completing the WV Needlestick Reporting Contact Information Form is essential for facilities to report needlestick and sharp object injuries effectively. This guide provides clear, step-by-step instructions to assist users in filling out the form online with accuracy and ease.
Follow the steps to successfully complete the form online.
- Click ‘Get Form’ button to access the form and open it in your preferred online editing tool.
- At the top of the form, enter the WVNIPP 4-Digit Facility Code if your facility has one. If you do not have a code, reach out to the Needlestick Prevention Program to get assigned a code.
- Provide the name of your facility in the designated field. Ensure the name is spelled correctly to avoid any confusion during reporting.
- Fill in the facility mailing address. Include complete details: street address, city, state, and zip code for proper correspondence.
- Enter the contact name for reporting purposes. This is the individual responsible for communication regarding needlestick reports.
- Provide a contact phone number. This should be a number where the reporting contact can be reached easily.
- Input the contact fax number, if available. This is useful for sending documents or reports when needed.
- Fill in the contact e-mail address. This will be used for electronic communications regarding reports.
- Indicate who completed the form by writing their name in the ‘Form Completed By’ section.
- Finally, include the date when the form is completed. This helps keep track of the reporting cycle.
- Once all fields are filled in correctly, save your changes. You may then download, print, or share the form as needed for submission.
Complete your WV Needlestick Reporting Contact Information Form online today to ensure timely and accurate reporting.
Immediately after the injury If you are at work, notify your supervisor or occupational health and safety officer - you will need to fill out an accident report form. Go straight to your doctor, or to the nearest hospital emergency department.
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