Nstructions: This form is to be used to report needlestick or sharps injuries by personnel in your organization responsible for reporting such incidents to the Public Employment Risk Reduction Program. It is preferred that the public employer submit all forms via the Internet. Public employer information 1) Employer: 2) Facility: Risk #: 3) Address: 4) City: 5) State: OH 6) ZIP code: 7) County: Address of reporter if different from facility where injury occurred (no P.O. boxes.
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How to fill out the OH BWC SH-12 online
Filling out the OH BWC SH-12 form online is an essential step in reporting needlestick or sharps injuries that occur within an organization. This guide will provide clear, step-by-step instructions to help you navigate the form efficiently and accurately.
Follow the steps to complete the form online.
- Click the ‘Get Form’ button to access the OH BWC SH-12 form and open it in your preferred editor.
- Begin by entering the information for your public employer in the designated fields. This includes the name of the employer, facility, risk number, address, city, state (Ohio), ZIP code, and county.
- If the address of the reporter is different from the facility where the injury occurred, provide that information in the given fields.
- Fill in the date the incident was reported, the name of the person reporting, and their phone number.
- Enter details regarding the injury itself, including the date and time of the injury, the age and sex of the injured person, and select the type of sharp involved in the incident from the provided options.
- Document the brand and model number of the sharp if known, along with the job classification and employment status of the injured person.
- Specify the type of location, facility, or agency where the injury occurred and detail the work area in which the injury took place.
- Describe the original intended use of the sharp and whether the injury occurred before, during, or after its intended purpose.
- Indicate involved body parts affected by the injury and answer questions about engineered sharps injury protection, protective mechanisms, glove usage, hepatitis B vaccination history, availability of a sharps container, and recent training related to exposure control.
- Complete the final sections regarding opinions on preventing the injury and provide explanations as necessary.
- Once all fields have been filled with accurate information, review the form for completeness before saving your changes, downloading, printing, or sharing the completed document.
Take action now and complete your OH BWC SH-12 form online to ensure proper reporting of sharps injuries.
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