Get the free SH-12 - Sharps Injury Form - Needlestick Report - State of Ohio

Sharps Injury Form Needle stick Report Public Employment Risk Reduction Program State of Ohio Division of Safety and Hygiene 13430 Yarmouth Drive Pickering ton, Ohio 43147 614-644-2246 or 800-671-6858

How to fill out sh-12 - sharps injury

How to Fill out SH-12 - Sharps Injury:

1. Provide personal information: Start by filling out your name, contact details, and job title. This ensures that the form is properly identified and filed correctly.
2. Describe the incident: Write a detailed account of the sharps injury incident, including the date, time, and location. Explain how it occurred and any contributing factors.
3. Identify the sharp object: Clearly state the type of sharp object involved in the injury, such as a needle, scalpel, or broken glass. Provide any relevant details, such as the brand or size of the object.
4. State the body part affected: Indicate the specific body part that was injured, whether it was a finger, hand, leg, etc. Be as precise as possible to ensure accurate reporting and proper treatment.
5. Include witness information: If there were any witnesses to the incident, provide their names and contact details. Their testimonies may be crucial for further investigation and documentation.
6. Provide medical treatment details: Describe the immediate steps taken for medical treatment, such as cleaning the wound, applying first aid, or seeking professional medical attention. Include the healthcare professional's name and contact information, if applicable.
7. Record prior vaccination history: Indicate whether you have been previously vaccinated for diseases such as hepatitis B or tetanus. This information helps healthcare providers determine if any additional medical interventions need to be taken.
8. Mention post-incident medical follow-up: If you sought ongoing medical care or follow-up appointments, note the dates and medical professionals involved. This ensures that proper treatment was received and assists in tracking the progress of your recovery.
9. Add any additional information: If there are any other relevant details about the incident that you believe should be documented, include them in this section.
10. Sign and date the form: Finally, sign the SH-12 form to certify that the information provided is accurate and complete. Include the date of filling out the form.

Who needs SH-12 - Sharps Injury?

1. Healthcare workers: Doctors, nurses, lab technicians, and other healthcare professionals who may come in contact with sharp objects during their work are required to fill out SH-12 forms in case of sharps injuries.
2. Laboratory personnel: Researchers, scientists, and technicians working in laboratories where sharp objects are frequently handled should also complete SH-12 forms if any sharps injuries occur.
3. Janitorial and maintenance staff: Individuals responsible for cleaning and disposing of medical waste or sharps containers may encounter sharps injuries, making it necessary for them to fill out SH-12 forms as well.
4. Other occupations involving sharps: Any occupation that involves handling sharp objects, such as tattoo artists, tattoo removal technicians, and waste management personnel, may also require the use of SH-12 forms in the event of a sharps injury.

For pdfFiller’s FAQs

What is sh-12 - sharps injury?

SH-12 - Sharps injury is a form used to report any injuries or accidents that involve sharps, such as needles, blades, or broken glass, in the workplace.

Who is required to file sh-12 - sharps injury?

The employers or individuals responsible for the workplace safety are required to file SH-12 - Sharps injury if there is any occurrence of sharps-related injuries at work.

How to fill out sh-12 - sharps injury?

To fill out SH-12 - Sharps injury form, you need to provide details about the injured person, the nature of the injury, any medical treatment required, and the circumstances surrounding the incident.

What is the purpose of sh-12 - sharps injury?

The purpose of SH-12 - Sharps injury is to ensure that any injuries or accidents involving sharps in the workplace are properly recorded, reported, and investigated to prevent future incidents and improve workplace safety.

What information must be reported on sh-12 - sharps injury?

The information that must be reported on SH-12 - Sharps injury includes details about the injured person, the date and time of the incident, the type of sharp object involved, the location of the incident, the nature and extent of the injury, and any medical treatment provided or required.

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