Exposure Control Plan
Maintenance & Management is committed to providing a safe and healthful work environment for our entire staff. In pursuit of this goal, the following exposure control plan (ECP) is provided to eliminate or minimize occupational exposure to blood borne pathogens in accordance with OSHA standard 29 CFR 1910.1030, “Occupational Exposure to Blood borne Pathogens.”
The ECP is a key document to assist our organization in implementing and ensuring compliance with the standard, thereby protecting our employees. This ECP includes:
■ Determination of employee exposure
■ Implementation of various methods of exposure control, including:
Universal precautions
Engineering and work practice controls
Personal protective equipment
Housekeeping
■ Hepatitis B vaccination
■ Post-exposure evaluation and follow-up
■ Communication of hazards to employees and training
■ Recordkeeping
■ Procedures for evaluating circumstances surrounding exposure incidents
Implementation methods for these elements of the standard are discussed in the subsequent pages of this ECP.
OCCUPATIONAL EXPOSURE
Occupational Exposure means reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee’s duties.
Other Potentially Infectious Materials (OPIM) include:
PROGRAM ADMINISTRATION
■ Maripat Downey, President, is responsible for implementation of the ECP. Maripat Downey, President, will maintain, review, and update the ECP at least annually, and whenever necessary to include new or modified tasks and procedures. Contact location/phone number: 843 Niagara Falls Blvd, Amherst, NY 14226, 716-836-2111.
■ Those employees who are determined to have occupational exposure to blood or other potentially infectious materials (OPIM) must comply with the procedures and work practices outlined in this ECP.
■ Site Supervisor will provide and maintain all necessary personal protective equipment (PPE). Site Supervisor will ensure that adequate supplies of the aforementioned equipment are available. Contact location/phone number: 843 Niagara Falls Blvd, Amherst, NY 14226, 716-836-2111.
■ Office Manager and Maripat Downey, President, will be responsible for ensuring that all medical actions required by the standard are performed and that appropriate employee health and OSHA records are maintained. Contact location/phone number: 843 Niagara Falls Blvd, Amherst, NY 14226, 716-836-2111.
■ Maripat Downey, President, will be responsible for documentation of training, and making the written ECP available to employees, OSHA, and NIOSH representatives. Contact location/phone number: 843 Niagara Falls Blvd, Amherst, NY 14226, 716-836-2111.
EMPLOYEE EXPOSURE DETERMINATION
The following is a list of job classifications in which some employees at our establishment have occupational exposure. Included is a list of tasks and procedures, or groups of closely related tasks and procedures, in which occupational exposure may occur for these individuals:
Job Title Department/Location Task/Procedure
Janitorial Staff All site locations Occasional (Small )Post-accident
Janitorial Staff Medical sites Daily general housekeeping/trash removal
METHODS OF IMPLEMENTATION AND CONTROL
Universal Precautions
All employees will utilize universal precautions, treating all human blood and certain human body fluids as if known to be infectious for HIV, HBV, and other blood borne pathogens.
As such, appropriate precautions will be taken such as the use of impermeable gloves, eye protection, and masks, including additional work practice controls to limit exposure.
Exposure Control Plan
Employees covered by the blood borne pathogens standard receive an explanation of this ECP during their initial training session. It will also be reviewed in their annual refresher training.
All employees can review this plan at any time during their work shifts by contacting Maripat Downey, President. If requested, we will provide an employee with a copy of the ECP free of charge and within 15 days of the request.
Engineering Controls and Work Practices
Engineering controls and work practice controls will be used to prevent or minimize exposure to blood borne pathogens. The specific engineering controls and work practice controls used are
listed below:
■ Employees are instructed not to touch sharps disposal containers or red bag regulated waste containers.
Personal Protective Equipment (PPE)
PPE is provided to our employees at no cost to them. Training in the use of the appropriate PPE for specific tasks or procedures is provided by the initial trainer and site Supervisor.
The types of PPE available to employees are as follows:
■ Gloves
■ Eye protection
■ Masks
PPE is located 843 Niagara Falls Blvd, Amherst, NY 14226 and may be obtained through the site Supervisor.
All employees using PPE must observe the following precautions:
■ Wash hands immediately or as soon as feasible after removing gloves or other PPE.
■ Remove PPE after it becomes contaminated and before leaving the work area.
■ Used PPE may be disposed of in the regular trash.
■ Wear appropriate gloves when it is reasonably anticipated that there may be hand contact with blood or OPIM, and when handling or touching contaminated items or surfaces; replace gloves if torn, punctured or contaminated, or if their ability to function as a barrier is compromised.
■ Never wash or decontaminate disposable gloves for reuse.
■ Wear appropriate face and eye protection when splashes, sprays, spatters, or droplets of blood or OPIM pose a hazard to the eye, nose, or mouth.
■ Remove immediately or as soon as feasible any garment contaminated by blood or OPIM, in such a way as to avoid contact with the outer surface.
HEPATITIS B VACCINATION
The site Supervisor will provide training to employees on hepatitis B vaccinations, addressing safety, benefits, efficacy, timing following exposure, methods of administration, and availability.
The hepatitis B vaccination series is available at no cost after initial employee training and within 10 days of initial assignment to all employees identified in the exposure determination section of this plan. Vaccination is encouraged unless: 1) documentation exists that the employee has previously received the series; 2) antibody testing reveals that the employee is immune; or 3) medical evaluation shows that vaccination is contraindicated.
Hepatitis B vaccinations are offered to all employees who work at medical sites.
However, if an employee declines the vaccination, the employee must sign a declination form (See Appendix A). Employees who decline may request and obtain the vaccination at a later date at no cost. Documentation of refusal of the vaccination is kept at 843 Niagara Falls Blvd., Amherst, NY 14226.
Vaccination will be provided by Health Works at WNY locations. A written report will be provided to the employee within 15 days following the completion of the medical evaluation and vaccine administration.
HEPATITIS C VIRUS (HCV)
Needle sticks are the most common cause of infection. There is no vaccination for HCV.
If an employee was involved in an incident where there was an exposure, a confidential medical evaluation will be offered.
HUMAN IMMUNODEFICIENCY VIRUS (HIV)
Needle sticks and cuts are the most common cause of infection. If an employee was involved in an incident where there was an exposure, a confidential medical evaluation will be offered. The employee should discuss treatment with prescription drugs, treatment risks, and side affects with their physician.
POST-EXPOSURE EVALUATION AND FOLLOW-UP
Should an exposure incident occur, contact Maripat Downey, President, at the following number: 716-836-2111.
Ensure initial first aid treatment and response is fully executed first.
An immediately available confidential medical evaluation and follow-up will be conducted by Health Works of WNY. Following initial first aid (clean the wound, flush eyes or other mucous membrane, etc.), the following activities will be performed:
■ Document the routes of exposure and how the exposure occurred.
■ Identify and document the source individual (unless the employer can establish that identification is infeasible or prohibited by state or local law).
■ Obtain consent and make arrangements to have the source individual tested as soon as possible to determine HIV, HCV, and HBV infectivity; document that the source individual’s test results
were conveyed to the employee’s health care provider.
■ If the source individual is already known to be HIV, HCV and/or HBV positive, new testing need not be performed.
■ Assure that the exposed employee is provided with the source individual’s test results and with information about applicable disclosure laws and regulations concerning the identity and
infectious status of the source individual (e.g., laws protecting confidentiality).
■ After obtaining consent, collect exposed employee’s blood as soon as feasible after exposure incident, and test blood for HBV and HIV serological status
■ If the employee does not give consent for HIV serological testing during collection of blood for baseline testing, preserve the baseline blood sample for at least 90 days; if the exposed employee elects to have the baseline sample tested during this waiting period, perform testing as soon as feasible.
ADMINISTRATION OF POST-EXPOSURE EVALUATION AND FOLLOW-UP
Maripat Downey, President, ensures that the health care professional evaluating an employee after an exposure incident receives the following:
■ a description of the employee’s job duties relevant to the exposure incident
■ route(s) of exposure
■ circumstances of exposure
■ if possible, results of the source individual’s blood test
■ relevant employee medical records, including vaccination status
PROCEDURES FOR EVALUATING THE CIRCUMSTANCES SURROUNDING AN EXPOSURE INCIDENT
Maripat Downey, President, will review the circumstances of all exposure incidents to determine:
■ engineering controls in use at the time
■ work practices followed
■ a description of the device being used (including type and brand)
■ protective equipment or clothing that was used at the time of the exposure incident (gloves, eye shields, etc.)
■ location of the incident
■ procedure being performed when the incident occurred
■ employee’s training
Maripat Downey, President, or the Office Manager will record all percutaneous injuries from contaminated sharps in a Sharps Injury Log.
EMPLOYEE TRAINING
All employees who have occupational exposure to blood borne pathogens receive initial and annual training conducted by the initial trainer and/or the site Supervisor.
All employees who have occupational exposure to bloodborne pathogens receive training on the epidemiology, symptoms, and transmission of bloodborne pathogen diseases. In addition, the
training program covers, at a minimum, the following elements:
■ a copy and explanation of the OSHA bloodborne pathogen standard fact sheet
■ an explanation of our ECP and how to obtain a copy
■ an explanation of methods to recognize tasks and other activities that may involve exposure to blood and OPIM, including what constitutes an exposure incident
■ an explanation of the use and limitations of engineering controls, work practices, and PPE
■ an explanation of the types, uses, location, removal, handling, decontamination, and disposal of PPE
■ an explanation of the basis for PPE selection
■ information on the hepatitis B vaccine, including information on its efficacy, safety, method of administration, the benefits of being vaccinated, and that the vaccine will be offered free of charge
■ information on the appropriate actions to take and persons to contact in an emergency involving blood or OPIM. Specifically:
■ information on the post-exposure evaluation and follow-up that the employer is required to provide for the employee following an exposure incident
■ an explanation of the signs and labels and/or color coding required by the standard and used at this facility
■ an opportunity for interactive questions and answers with the person conducting the training session.
Training materials for this facility are available at 843 Niagara Falls Blvd., Amherst, NY 14226.
RECORDKEEPING
Training Records
Training records are completed for each employee upon completion of training. These documents will be kept for at least three years at 843 Niagara Falls Blvd., Amherst, NY 14226.
The training records include:
■ the dates of the training sessions
■ the contents or a summary of the training sessions
■ the names of persons conducting the training
■ the names of all persons attending the training sessions
Employee training records are provided upon request to the employee or the employee’s authorized representative within 15 working days. Such requests should be addressed to
Maripat Downey, President.
Medical Records
Medical records are maintained for each employee with occupational exposure in accordance with 29 CFR 1910.1020, “Access to Employee Exposure and Medical Records.”
The Office Manager is responsible for maintenance of the required medical records. These confidential records are kept in the office at 843 Niagara Falls Blvd., Amherst, NY 14226, or at the storage facility at 3671 Sheridan Dr., Amherst, NY 14226 for at least the duration of employment plus 30 years.
Employee medical records are provided upon request of the employee or to anyone having written consent of the employee within 15 working days. Such requests should be sent to
Maripat Downey, President.
OSHA Recordkeeping
An exposure incident is evaluated to determine if the case meets OSHA’s Recordkeeping Requirements (29 CFR 1904). This determination and the recording activities are done by the Office Manager.
Sharps Injury Log
In addition to the 1904 Recordkeeping Requirements, all percutaneous injuries from contaminated sharps are also recorded in a Sharps Injury Log (See Appendix B). All incidences must include at least:
■ date of the injury
■ type and brand of the device involved (syringe, suture needle)
■ department or work area where the incident occurred
■ explanation of how the incident occurred.
This log is reviewed as part of the annual program evaluation and maintained for at least five years following the end of the calendar year covered. If a copy is requested by anyone, it must
have any personal identifiers removed from the report.
APPENDIX A
HEPATITIS B VACCINE DECLINATION (MANDATORY)
I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring hepatitis B virus (HBV) infection. I have been given the opportunity to be vaccinated with hepatitis B vaccine, at no charge to myself.
However, I decline hepatitis B vaccination at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring hepatitis B, a serious disease. If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with hepatitis B vaccine, I can receive the vaccination series at no charge to me.
Signed: (Employee Name)________________ Date:________________
APPENDIX B
SHARPS INJURY LOG
The ECP is a key document to assist our organization in implementing and ensuring compliance with the standard, thereby protecting our employees. This ECP includes:
■ Determination of employee exposure
■ Implementation of various methods of exposure control, including:
Universal precautions
Engineering and work practice controls
Personal protective equipment
Housekeeping
■ Hepatitis B vaccination
■ Post-exposure evaluation and follow-up
■ Communication of hazards to employees and training
■ Recordkeeping
■ Procedures for evaluating circumstances surrounding exposure incidents
Implementation methods for these elements of the standard are discussed in the subsequent pages of this ECP.
OCCUPATIONAL EXPOSURE
Occupational Exposure means reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee’s duties.
Other Potentially Infectious Materials (OPIM) include:
- Semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood.
- All body fluids in situations where it is difficult or impossible to differentiate between body fluids.
- Any unfixed tissue or organ (other than intact skin) from a human (living or dead).
- HIV-containing cells or tissue cultures, organ cultures, and HIV- or HBV-containing culture medium or other solutions.
- Blood, organs, or other tissues from experimental animals infected with HIV or HBV.
PROGRAM ADMINISTRATION
■ Maripat Downey, President, is responsible for implementation of the ECP. Maripat Downey, President, will maintain, review, and update the ECP at least annually, and whenever necessary to include new or modified tasks and procedures. Contact location/phone number: 843 Niagara Falls Blvd, Amherst, NY 14226, 716-836-2111.
■ Those employees who are determined to have occupational exposure to blood or other potentially infectious materials (OPIM) must comply with the procedures and work practices outlined in this ECP.
■ Site Supervisor will provide and maintain all necessary personal protective equipment (PPE). Site Supervisor will ensure that adequate supplies of the aforementioned equipment are available. Contact location/phone number: 843 Niagara Falls Blvd, Amherst, NY 14226, 716-836-2111.
■ Office Manager and Maripat Downey, President, will be responsible for ensuring that all medical actions required by the standard are performed and that appropriate employee health and OSHA records are maintained. Contact location/phone number: 843 Niagara Falls Blvd, Amherst, NY 14226, 716-836-2111.
■ Maripat Downey, President, will be responsible for documentation of training, and making the written ECP available to employees, OSHA, and NIOSH representatives. Contact location/phone number: 843 Niagara Falls Blvd, Amherst, NY 14226, 716-836-2111.
EMPLOYEE EXPOSURE DETERMINATION
The following is a list of job classifications in which some employees at our establishment have occupational exposure. Included is a list of tasks and procedures, or groups of closely related tasks and procedures, in which occupational exposure may occur for these individuals:
Job Title Department/Location Task/Procedure
Janitorial Staff All site locations Occasional (Small )Post-accident
Janitorial Staff Medical sites Daily general housekeeping/trash removal
METHODS OF IMPLEMENTATION AND CONTROL
Universal Precautions
All employees will utilize universal precautions, treating all human blood and certain human body fluids as if known to be infectious for HIV, HBV, and other blood borne pathogens.
As such, appropriate precautions will be taken such as the use of impermeable gloves, eye protection, and masks, including additional work practice controls to limit exposure.
Exposure Control Plan
Employees covered by the blood borne pathogens standard receive an explanation of this ECP during their initial training session. It will also be reviewed in their annual refresher training.
All employees can review this plan at any time during their work shifts by contacting Maripat Downey, President. If requested, we will provide an employee with a copy of the ECP free of charge and within 15 days of the request.
Engineering Controls and Work Practices
Engineering controls and work practice controls will be used to prevent or minimize exposure to blood borne pathogens. The specific engineering controls and work practice controls used are
listed below:
■ Employees are instructed not to touch sharps disposal containers or red bag regulated waste containers.
Personal Protective Equipment (PPE)
PPE is provided to our employees at no cost to them. Training in the use of the appropriate PPE for specific tasks or procedures is provided by the initial trainer and site Supervisor.
The types of PPE available to employees are as follows:
■ Gloves
■ Eye protection
■ Masks
PPE is located 843 Niagara Falls Blvd, Amherst, NY 14226 and may be obtained through the site Supervisor.
All employees using PPE must observe the following precautions:
■ Wash hands immediately or as soon as feasible after removing gloves or other PPE.
■ Remove PPE after it becomes contaminated and before leaving the work area.
■ Used PPE may be disposed of in the regular trash.
■ Wear appropriate gloves when it is reasonably anticipated that there may be hand contact with blood or OPIM, and when handling or touching contaminated items or surfaces; replace gloves if torn, punctured or contaminated, or if their ability to function as a barrier is compromised.
■ Never wash or decontaminate disposable gloves for reuse.
■ Wear appropriate face and eye protection when splashes, sprays, spatters, or droplets of blood or OPIM pose a hazard to the eye, nose, or mouth.
■ Remove immediately or as soon as feasible any garment contaminated by blood or OPIM, in such a way as to avoid contact with the outer surface.
HEPATITIS B VACCINATION
The site Supervisor will provide training to employees on hepatitis B vaccinations, addressing safety, benefits, efficacy, timing following exposure, methods of administration, and availability.
The hepatitis B vaccination series is available at no cost after initial employee training and within 10 days of initial assignment to all employees identified in the exposure determination section of this plan. Vaccination is encouraged unless: 1) documentation exists that the employee has previously received the series; 2) antibody testing reveals that the employee is immune; or 3) medical evaluation shows that vaccination is contraindicated.
Hepatitis B vaccinations are offered to all employees who work at medical sites.
However, if an employee declines the vaccination, the employee must sign a declination form (See Appendix A). Employees who decline may request and obtain the vaccination at a later date at no cost. Documentation of refusal of the vaccination is kept at 843 Niagara Falls Blvd., Amherst, NY 14226.
Vaccination will be provided by Health Works at WNY locations. A written report will be provided to the employee within 15 days following the completion of the medical evaluation and vaccine administration.
HEPATITIS C VIRUS (HCV)
Needle sticks are the most common cause of infection. There is no vaccination for HCV.
If an employee was involved in an incident where there was an exposure, a confidential medical evaluation will be offered.
HUMAN IMMUNODEFICIENCY VIRUS (HIV)
Needle sticks and cuts are the most common cause of infection. If an employee was involved in an incident where there was an exposure, a confidential medical evaluation will be offered. The employee should discuss treatment with prescription drugs, treatment risks, and side affects with their physician.
POST-EXPOSURE EVALUATION AND FOLLOW-UP
Should an exposure incident occur, contact Maripat Downey, President, at the following number: 716-836-2111.
Ensure initial first aid treatment and response is fully executed first.
- Protect yourself or anyone else involved in an exposure response.
- Clean the wound by washing injuries with soap.
- Flush and irrigate with water any splashes to the nose, mouth, skin or other mucous membranes. Caustics and bleach are not recommended.
- Irrigate eyes with clean water, sterile irrigants, or saline solution.
- Secure necessary medical attention appropriate to the incident immediately.
- Make a prompt report of the incident to your manger.
- All near misses as well as incidents are to be recorded.
An immediately available confidential medical evaluation and follow-up will be conducted by Health Works of WNY. Following initial first aid (clean the wound, flush eyes or other mucous membrane, etc.), the following activities will be performed:
■ Document the routes of exposure and how the exposure occurred.
■ Identify and document the source individual (unless the employer can establish that identification is infeasible or prohibited by state or local law).
■ Obtain consent and make arrangements to have the source individual tested as soon as possible to determine HIV, HCV, and HBV infectivity; document that the source individual’s test results
were conveyed to the employee’s health care provider.
■ If the source individual is already known to be HIV, HCV and/or HBV positive, new testing need not be performed.
■ Assure that the exposed employee is provided with the source individual’s test results and with information about applicable disclosure laws and regulations concerning the identity and
infectious status of the source individual (e.g., laws protecting confidentiality).
■ After obtaining consent, collect exposed employee’s blood as soon as feasible after exposure incident, and test blood for HBV and HIV serological status
■ If the employee does not give consent for HIV serological testing during collection of blood for baseline testing, preserve the baseline blood sample for at least 90 days; if the exposed employee elects to have the baseline sample tested during this waiting period, perform testing as soon as feasible.
ADMINISTRATION OF POST-EXPOSURE EVALUATION AND FOLLOW-UP
Maripat Downey, President, ensures that the health care professional evaluating an employee after an exposure incident receives the following:
■ a description of the employee’s job duties relevant to the exposure incident
■ route(s) of exposure
■ circumstances of exposure
■ if possible, results of the source individual’s blood test
■ relevant employee medical records, including vaccination status
PROCEDURES FOR EVALUATING THE CIRCUMSTANCES SURROUNDING AN EXPOSURE INCIDENT
Maripat Downey, President, will review the circumstances of all exposure incidents to determine:
■ engineering controls in use at the time
■ work practices followed
■ a description of the device being used (including type and brand)
■ protective equipment or clothing that was used at the time of the exposure incident (gloves, eye shields, etc.)
■ location of the incident
■ procedure being performed when the incident occurred
■ employee’s training
Maripat Downey, President, or the Office Manager will record all percutaneous injuries from contaminated sharps in a Sharps Injury Log.
EMPLOYEE TRAINING
All employees who have occupational exposure to blood borne pathogens receive initial and annual training conducted by the initial trainer and/or the site Supervisor.
All employees who have occupational exposure to bloodborne pathogens receive training on the epidemiology, symptoms, and transmission of bloodborne pathogen diseases. In addition, the
training program covers, at a minimum, the following elements:
■ a copy and explanation of the OSHA bloodborne pathogen standard fact sheet
■ an explanation of our ECP and how to obtain a copy
■ an explanation of methods to recognize tasks and other activities that may involve exposure to blood and OPIM, including what constitutes an exposure incident
■ an explanation of the use and limitations of engineering controls, work practices, and PPE
■ an explanation of the types, uses, location, removal, handling, decontamination, and disposal of PPE
■ an explanation of the basis for PPE selection
■ information on the hepatitis B vaccine, including information on its efficacy, safety, method of administration, the benefits of being vaccinated, and that the vaccine will be offered free of charge
■ information on the appropriate actions to take and persons to contact in an emergency involving blood or OPIM. Specifically:
- We are NOT to handle any sharps. Upon seeing a sharp that has not been disposed of properly by medical personnel, contact your on-site cleaning ‘lead’. The lead will contact Maripat Downey. Maripat will contact the Director of the facility regarding educating their staff on proper sharps disposal. If a sharp should be found, a broom and dustpan are to be used for disposal into a sharps container.
■ information on the post-exposure evaluation and follow-up that the employer is required to provide for the employee following an exposure incident
■ an explanation of the signs and labels and/or color coding required by the standard and used at this facility
■ an opportunity for interactive questions and answers with the person conducting the training session.
Training materials for this facility are available at 843 Niagara Falls Blvd., Amherst, NY 14226.
RECORDKEEPING
Training Records
Training records are completed for each employee upon completion of training. These documents will be kept for at least three years at 843 Niagara Falls Blvd., Amherst, NY 14226.
The training records include:
■ the dates of the training sessions
■ the contents or a summary of the training sessions
■ the names of persons conducting the training
■ the names of all persons attending the training sessions
Employee training records are provided upon request to the employee or the employee’s authorized representative within 15 working days. Such requests should be addressed to
Maripat Downey, President.
Medical Records
Medical records are maintained for each employee with occupational exposure in accordance with 29 CFR 1910.1020, “Access to Employee Exposure and Medical Records.”
The Office Manager is responsible for maintenance of the required medical records. These confidential records are kept in the office at 843 Niagara Falls Blvd., Amherst, NY 14226, or at the storage facility at 3671 Sheridan Dr., Amherst, NY 14226 for at least the duration of employment plus 30 years.
Employee medical records are provided upon request of the employee or to anyone having written consent of the employee within 15 working days. Such requests should be sent to
Maripat Downey, President.
OSHA Recordkeeping
An exposure incident is evaluated to determine if the case meets OSHA’s Recordkeeping Requirements (29 CFR 1904). This determination and the recording activities are done by the Office Manager.
Sharps Injury Log
In addition to the 1904 Recordkeeping Requirements, all percutaneous injuries from contaminated sharps are also recorded in a Sharps Injury Log (See Appendix B). All incidences must include at least:
■ date of the injury
■ type and brand of the device involved (syringe, suture needle)
■ department or work area where the incident occurred
■ explanation of how the incident occurred.
This log is reviewed as part of the annual program evaluation and maintained for at least five years following the end of the calendar year covered. If a copy is requested by anyone, it must
have any personal identifiers removed from the report.
APPENDIX A
HEPATITIS B VACCINE DECLINATION (MANDATORY)
I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring hepatitis B virus (HBV) infection. I have been given the opportunity to be vaccinated with hepatitis B vaccine, at no charge to myself.
However, I decline hepatitis B vaccination at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring hepatitis B, a serious disease. If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with hepatitis B vaccine, I can receive the vaccination series at no charge to me.
Signed: (Employee Name)________________ Date:________________
APPENDIX B
SHARPS INJURY LOG