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Needle stick injury reporting form pdf

Needle stick injury reporting form pdf 2026

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The document is a Sharps Injury Form used to report needlestick or sharps injuries by personnel in Ohio's public sector. It includes sections for employer and injury information, detailing the circumstances of the injury, type of sharp involved, and safety measures in place. The form aims to facilitate reporting to the Public Employment Risk Reduction Program.

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Click ‘Get Form’ to open the needle stick injury reporting form in the editor.
Begin by filling out the 'Public employer information' section. Enter the employer's name, facility, address, city, state, ZIP code, and county.
Provide the reporter's details if different from the facility. Include the date reported, name of the reporter, and their phone number.
In the 'Injury information' section, input the date and time of injury, age and sex of the injured person. Select the type of sharp involved from the provided options.
Continue by entering additional details such as brand name (or 'unknown'), model number, job classification, and employment status of the injured person.
Specify where the injury occurred and its original intended use. Complete any relevant questions regarding safety measures taken at the time of injury.
Review all entered information for accuracy before submitting your report through our platform for a streamlined process.

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What is necessary when filing an injury report after a needlestick?

(a) Basic requirement. You must record all work-related needlestick injuries and cuts from sharp objects that are contaminated with another persons blood or other potentially infectious material (as defined by Title 8, Section 5193). You must enter the case on the Cal/OSHA Form 300 as an injury.

How do you document a needle stick injury?

You must record all work-related needlestick injuries and cuts from sharp objects that are contaminated with another persons blood or other potentially infectious material (as defined by 29 CFR 1910.1030). You must enter the case on the OSHA 300 Log as an injury.

How to write an incident report for needle stick injury?

9) Date of injury: 10) Time of injury: 13) Type of Sharp: Needle. Surgical instrument (non glass) Glass. 16) Job classification of injured person: 17) Employment status of injured person: 18) Type of location/facility/agency where sharps injury occurred: 19) Work area where sharps injury occurred (select best choice):

What information is necessary when filing an injury report after a needlestick?

Critical information to collect for reporting purposes includes the following details: Date and time of the exposure. Procedure or action being performed during the injury. Specific information about the exposure (e.g., profession, department or unit, shift, injury to user or non-user, etc.)

What are the CDC guidelines for needle stick injury?

Seek medical care to determine risk associated with exposure. Report blood and body fluid exposure immediately as it poses a risk of infection transmission. Reporting as soon as possible will assist obtaining a test from the source.

needle stick injury reporting form

OSHA 300A Form PDF OSHA Incident Report form OSHA forms printable Employee accident report form PDF OSHA Form 300 OSHA 300 Log Excel OSHA 300A form PDF fillable Fillable OSHA 300A form

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How to report a needle stick injury?

Immediately after the injury If you are at work, notify your supervisor or occupational health and safety officer - you will need to fill out an accident report form. Go straight to your doctor, or to the nearest hospital emergency department.

What is the protocol after a needlestick injury?

The site should be immediately washed with soap and water. The incident should be reported and an exposure report sheet completed. The exposure should be assessed (type of fluid, type of needle, amount of blood on the needle, etc). available to be tested.