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Massachusetts Department of Public Health Blood-borne Pathogen Exposure Incident Recording FormEMPLOYER:*UNIQUE EXPOSURE INCIDENT NUMBER:* EXPOSED WORKERS NAME: (or unique ID number) OSHA RECORDABLE:
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How to fill out bloodborne pathogen exposure incident

01
Put on personal protective equipment, such as disposable gloves, goggles, and a face mask.
02
Clean the affected area with soap and water.
03
If there is visible blood, use a solution of 1 part bleach to 10 parts water to disinfect the area.
04
Document the incident by filling out an exposure incident report form.
05
Provide detailed information about the exposure, including the location, date, time, and nature of the incident.
06
Include information about the source of the exposure, such as the name and contact information of the individual involved.
07
Describe the type of exposure, such as a needlestick or splash to the mucous membranes.
08
Record any symptoms or medical issues that have arisen as a result of the exposure.
09
Submit the completed form to the appropriate department or supervisor for review and follow-up.
10
Follow any additional protocols or procedures as directed by healthcare professionals or relevant authorities.

Who needs bloodborne pathogen exposure incident?

01
Anyone who has been exposed to blood or other potentially infectious materials (OPIM) needs to fill out a bloodborne pathogen exposure incident form.
02
This includes healthcare workers, first responders, laboratory personnel, and any individual who may come into contact with blood or OPIM in their work environment.
03
It is important to report and document exposure incidents to ensure appropriate medical follow-up and to prevent the spread of bloodborne pathogens.

What is Bloodborne Pathogen Exposure Incident Recording Form?

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An exposure incident is a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee's duties.
Employers are required to file a report of any bloodborne pathogen exposure incident.
The incident report should include details such as the date and time of exposure, how the exposure occurred, and any medical treatment provided.
The purpose of reporting bloodborne pathogen exposure incidents is to ensure that proper follow-up and prevention measures are taken to protect the health and safety of employees.
Information such as the date and time of exposure, how the exposure occurred, and any medical treatment provided must be reported on the incident report.
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