Get Exposure Incident Report Employee's/ Student's Name Date Date Of ...

Filling out the Exposure Incident Report is crucial for documenting the details of any exposure incidents effectively. This guide will assist you in navigating each section of the form accurately and efficiently, ensuring that all necessary information is provided clearly.

Follow the steps to complete the Exposure Incident Report online.

1. Press the ‘Get Form’ button to access the Exposure Incident Report and open it in your preferred editor.
2. Complete the Employee's/Student's Name field by entering the full name of the individual involved in the incident.
3. Fill in the Date field with the current date when filling out the report.
4. Input the Date of Birth of the individual, ensuring to use the correct format.
5. Enter the Social Security Number (SS #) to ensure proper identification.
6. Provide both business and home telephone numbers for contact purposes.
7. Specify the Job Title of the individual to clarify their role at the time of the incident.
8. Record the Date of Exposure, which should reflect the actual date when the incident occurred.
9. Indicate the Time of Exposure by selecting whether it occurred in the AM or PM.
10. Document the Hepatitis B Vaccination Status, ensuring compliance with relevant health regulations.
11. Describe the Location of the Incident clearly, so it can be identified easily.
12. In the designated section, explain the job duties being performed at the time of exposure.
13. Clearly describe the circumstances leading to the exposure incident, detailing how it occurred.
14. List the body fluid(s) involved in the exposure incident.
15. Specify the route of exposure (e.g., mucosal contact, broken skin, percutaneous) clearly.
16. Detail any personal protective equipment (PPE) that was in use at the time of the incident.
17. Indicate whether the PPE failed during the incident and describe how it failed if applicable.
18. Provide identification details of the source individual(s), including names and phone numbers.
19. Include any other pertinent information that may assist in understanding the incident.
20. Ensure that the Employee/Student signature and date, as well as the Supervisor/Faculty Member signature and date, are completed.

Complete the Exposure Incident Report online to ensure accurate documentation of exposure incidents.