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A form for nursing students to acknowledge their understanding of blood-borne pathogens and confirm they have accessed and understood necessary safety protocols.
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How to fill out blood-borne pathogens acknowledgment form

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How to fill out Blood-Borne Pathogens Acknowledgment Form

01
Obtain the Blood-Borne Pathogens Acknowledgment Form from your supervisor or the relevant department.
02
Read the instructions and information provided on the form carefully.
03
Fill in your name and personal details as required at the top of the form.
04
Review the section regarding training on Blood-Borne Pathogens and confirm that you have received this training.
05
Sign and date the form to acknowledge your understanding of the risks and necessary precautions.
06
Submit the completed form to your supervisor or designated personnel.

Who needs Blood-Borne Pathogens Acknowledgment Form?

01
Employees who might be exposed to blood or other potentially infectious materials in the workplace.
02
Health care workers, medical staff, and laboratory personnel.
03
Individuals in positions that require handling of biological materials or are in contact with clients/patients in healthcare settings.
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This course uses the PACT acronym (Protect, Act, Clean, Tell) and tagline, “Make a PACT, Know How to Act™,” to help students learn and easily recall bloodborne pathogens training. Students learn how to: Protect themselves from blood or blood-containing materials. Act quickly and safely.
Wash needlesticks and cuts with soap and water. Flush splashes to nose, mouth, or skin with water. Irrigate eyes with clean water, saline, or sterile wash. Report all exposures promptly to ensure that you receive appropriate followup care.
Exposed person (staff member or patient): Decontaminate exposed area, (eg wash wound, rinse eyes if splashed). Report exposure immediately. Obtain or arrange referral for assessment and possible prophylaxis immediately. Ensure the incident is documented.
​Bloodborne pathogens are microorganisms such as viruses or bacteria that are carried in blood and can cause disease in people. There are many different bloodborne pathogens, including malaria, syphilis, and brucellosis, and most notably Hepatitis B (HBV), Hepatitis C (HCV) and the Human Immunodeficiency Virus (HIV).
Wash needlesticks and cuts with soap and water. Flush splashes to nose, mouth, or skin with water. Irrigate eyes with clean water, saline, or sterile wash. Report all exposures promptly to ensure that you receive appropriate followup care.
How Do You Get Certified in Bloodborne Pathogen Training? American Red Cross offers flexible BBP training classes that meet OSHA certification requirements for workplaces and healthcare providers. Our Bloodborne Pathogens Training Online course is one of the requirements of the OSHA Bloodborne Pathogens Standard.
If you are stuck by a needle or other sharp or get blood or other potentially infectious materials in your eyes, nose, mouth, or on broken skin, immediately flood the exposed area with water and clean any wound with soap and water or a skin disinfectant if available.
To receive a Bloodborne Pathogens certificate, you must complete a training course that satisfies CDC and OSHA training requirements. Once you successfully complete the course, you'll receive a downloadable certificate that you can print out or email to your employer.
Bloodborne pathogens are infectious microorganisms in human blood that can cause disease in humans.
Bloodborne pathogens (BBP) are infectious microorganisms that may be present in human blood and other potentially infectious materials (OPIM), including hepatitis B and C viruses and human immunodeficiency virus (HIV).

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The Blood-Borne Pathogens Acknowledgment Form is a document that recognizes an individual's understanding of the risks associated with exposure to blood-borne pathogens and the safety protocols necessary to minimize those risks.
Employees who may be exposed to blood or other potentially infectious materials during their work, especially those in health care or related fields, are required to file the Blood-Borne Pathogens Acknowledgment Form.
To fill out the Blood-Borne Pathogens Acknowledgment Form, individuals must provide their personal information, acknowledge receipt of training regarding blood-borne pathogens, and sign the form to confirm their understanding and compliance with the safety protocols.
The purpose of the Blood-Borne Pathogens Acknowledgment Form is to ensure that individuals are aware of the risks associated with blood-borne pathogens, have received necessary training, and agree to follow established safety protocols to protect themselves and others.
The Blood-Borne Pathogens Acknowledgment Form must report the individual's name, job title, department, date of training, acknowledgment of training received, and signature confirming their understanding of the risks and required safety procedures.
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