Infectious Disease Exposure form-ALL but Police - Pittsburgh 2026

1. Click ‘Get Form’ to open the Infectious Disease Exposure form in the editor.
2. Begin by entering the INCIDENT/CCR NUMBER at the top of the form. This is crucial for tracking your report.
3. Fill in the ADDRESS OF INCIDENT, ensuring you provide a complete street address for accurate documentation.
4. Specify your DEPARTMENT and UNIT/DIVISION to identify where you work within the organization.
5. Enter your EMPLOYEE NAME, ADDRESS, OCCUPATION, and PHONE numbers (both home and work) to ensure proper identification.
6. Provide the SUBJECT'S NAME AND/OR SOURCE OF EXPOSURE along with their SEX and AGE if applicable.
7. Document the DATE OF POTENTIAL EXPOSURE and include any known details about the potential exposure, such as type of body fluid or suspected disease.
8. In the DESCRIPTION OF INCIDENT section, detail how the exposure occurred, including routes of entry and circumstances surrounding it.
9. List INDIVIDUALS INVOLVED IN THE INCIDENT by providing their names and nature of involvement. Include contact information where possible.
10. Finally, sign and date where indicated for both EMPLOYEE SIGNATURE and SUPERVISOR SIGNATURE before submitting your report as instructed.

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