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- Click ‘Get Form’ to open the needle stick injury incident report sample in the editor.
- Begin by filling out the 'Personal Details' section. Enter your last name, first name, date of birth, and select your status (Student, Employee, Visitor/Contractor). Provide your home address, email, and contact phone numbers.
- Complete the 'Incident Details' section. Record the date and time of the incident. Describe how it occurred, including details about protective garments worn and the nature of exposure.
- If applicable, provide contact details for any witnesses and source patients. Indicate if the source is known to be positive for HIV or Hepatitis.
- In the 'Follow Up Action' section, specify any medical treatment received and describe first aid provided. Answer questions regarding Hepatitis B vaccination history.
- Finally, sign and date the form. Once completed, print it and fax it to the Risk Management Office as instructed.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2007 | 4 Satisfied (49 Votes) |
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