Exposure form 2026

1. Click ‘Get Form’ to open the exposure form in the editor.
2. Begin by entering the exposed member’s name, position, and social security number in the designated fields. Ensure accuracy for proper documentation.
3. Fill in the home phone number, field incident number, shift, and company details to provide context for the exposure.
4. Document patient information including name, age, sex, and address. This is crucial for tracking potential disease transmission.
5. Indicate whether the suspected disease is confirmed or not and detail where the patient was transported and by whom.
6. Record the date and time of exposure along with a description of the incident type (e.g., auto accident).
7. Specify what protective equipment was utilized during the incident and list any bodily fluids you were exposed to from the provided options.
8. Detail any specific body parts that were exposed and whether there were any open cuts or sores at that time.
9. Explain how the exposure occurred and indicate if medical attention was sought. If yes, provide details about where and when.
10. Complete sections for infection control supervisor's report including facility notification status and follow-up actions required.

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