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APPENDIX F CONTAGIOUS DISEASE EXPOSURE REPORT FORM This form must be faxed to the County Health Officer immediately. Agency: Agency Report Number: FIELD PERSONNEL ONLY Name(s) of exposed: 1. 2. 3.

How to fill out contagious disease exposure report

How to fill out a contagious disease exposure report:

1. Begin by accessing the contagious disease exposure report form. This form can typically be found on the website of the local health department or through your employer's human resources department.
2. Fill out the personal information section of the report. This may include your full name, contact information, and any relevant identification numbers or employee IDs.
3. Provide details about the contagious disease exposure incident. Describe the nature of the exposure, such as whether it occurred through direct contact with an infected individual or in a high-risk environment.
4. Include the date and time of the exposure incident. Accuracy is crucial in this section, so try to recall the exact details of when the exposure occurred.
5. Provide information about the contagious disease itself. This may include the name or type of disease, any symptoms exhibited by the exposed individual or affected parties, and any known diagnosis or test results.
6. Describe any steps taken following the exposure incident. This may include seeking medical attention, receiving vaccinations or prophylactic treatments, or following any specific protocols provided by health authorities.
7. If applicable, provide information about any individuals who may have also been exposed. This could include coworkers, family members, or anyone who may have come into contact with the exposed individual.
8. Sign and date the form to certify the accuracy of the information provided. This confirms that you are responsible for the information provided and understand the implications of the report.

Who needs a contagious disease exposure report?

1. Healthcare professionals: Medical practitioners, nurses, and other healthcare providers are often required to fill out a contagious disease exposure report due to their increased risk of encountering contagious diseases in their line of work.
2. Employees: Certain occupations, such as those working in high-risk environments like laboratories, animal shelters, or childcare settings, may require their employees to complete a contagious disease exposure report in case of any potential exposures.
3. Individuals who have been exposed: If you have been exposed to a contagious disease, either through direct contact or being in a high-risk location, it is important to fill out a contagious disease exposure report to help track and prevent the further spread of the disease.

Note: The specific requirements for a contagious disease exposure report may vary depending on your location and the organization you are affiliated with. Always refer to the guidelines provided by your local health department or employer for accurate and up-to-date information.

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What is contagious disease exposure report?

Contagious disease exposure report is a document that records instances where individuals may have been exposed to a contagious disease.

Who is required to file contagious disease exposure report?

Healthcare providers, employers, and public health authorities may be required to file contagious disease exposure reports.

How to fill out contagious disease exposure report?

Contagious disease exposure reports can be filled out by providing details of the individuals exposed, the disease in question, and the circumstances of the exposure.

What is the purpose of contagious disease exposure report?

The purpose of contagious disease exposure report is to track and monitor instances of contagious disease exposure in order to prevent further spread of the disease.

What information must be reported on contagious disease exposure report?

The information reported on contagious disease exposure report may include the name of the exposed individuals, the type of disease, the date of exposure, and any symptoms experienced.