Unprotected exposure form ma 2026

1. Click ‘Get Form’ to open the unprotected exposure form in the editor.
2. Begin by entering today’s date and the incident date at the top of the form. Ensure these dates are accurate for proper documentation.
3. Fill in the transporting ambulance service and receiving facility details, including the ambulance trip report number and address.
4. Provide information about the Designated Infection Control Officer (DICO) by typing or printing their name and telephone number.
5. Complete the patient information section, including name, incident location, and type of incident (medical, trauma, etc.).
6. In the rescuer information section, enter your name, profession, department/employer, and contact numbers.
7. Check all applicable boxes regarding exposure route (e.g., needlestick) and type (e.g., blood). Provide detailed explanations in the designated areas.
8. Describe any precautions taken during the incident and detail any steps you took to minimize exposure.
9. Review all entered information for accuracy before saving or exporting your completed form.

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