Free printable visual learning guides for safe sharps. Fill in the one circle corresponding to the most appropriate answer. Attempting to view or print pdf files through your browser with a plugin viewer, can result in various technical difficulties. When accessing the pdf file below, right click on the link and save the file directly to your computer. Osha injury and illness recordkeeping and reporting. Injury occurred before, during or after activation of mechanism. No personal employee identifiers are allowed in the log. The purpose of the log is to prevent future incidents from occurring.
The information in the sharps injury log shall be recorded and maintained in such manner as to protect the confidentiality of the injured employee. Log for recording all percutaneous injuries occurring from contaminated sharps. Several pages of the log but you may make as many copies of the log as you need. A sharps injury means any injury caused by a sharp, including but not limited to cuts, abra sions, or needlesticks. Sharps injury prevention list and information march 2016 in all workplaces where employees are exposed to contaminated needles or other contaminated sharps, the employer shall comply with 29cfr 1910. The international safety center provides epinet training across the united states and around the world. Sample occupational sharps injury log addendum a supplement. Prevention act of 2000 and the 2001 revised bloodborne pathogens standard require healthcare facilities to maintain a sharps injury log. Sharps injury means any injury caused by a sharp, including, but not limited to, cuts, abrasions, or needlesticks. Forms 300, 300a, 301 and instructions pdf fillable format forms 300, 300a, 301 excel format forms only. Occupational sharps injury log addendum a supplement to osha 300 and 301 forms insert your organizations confidentiality statement, instructions for completing log and obtaining medical care here.
Sop format template personal loan contracts sample p and l statement sharps injury log template12811656 sharps injury log fill line printable fillable blank sharps injury log template298230 exposure control plan template sharps injury log template260336 log sheet template. Medical facilities checklist pdf osha sharps device list. Sharps injury prevention workbook centers for disease control. In the corresponding right hand box, select one or two circumstances that reflect how the injury happened. Complete instructional packet for forms 300, 300a, 301 and instructions pdf xls. Toprequested sites to log in to services provided by the state virtual gateway. The log must be maintained in a manner to protect the confidentiality of the injured employee. Sharps injury log fill out and sign printable pdf template. Sharps injury log pdf request for source individual evaluation pdf sample training outline and quiz pdf training documentation form pdf selecting sharps containers us public health service sample cleaning schedule pdf sequence for putting on ppe pdf technical support. Sharps injury log template pdf fill out and sign printable. Sharps injury log template indiana state university. This includes all work related needlestick injuries and cuts from sharp objects that are contaminated with another persons blood or other.
Call our tollfree line 18009222689 or call your nearest. Making the best use of your sharps injury log infection. Workbook for designing, implementing, and evaluating a. The occupational safety and health osha bloodborne pathogens standard 1910. For more information, see oar 437001070020, employee involvement. Which health care employees are eligible for free hepatitis b vaccination. Date and time department position location of incident body part injured device type device brand how injury occurred device had protective mechanism. Record all workrelated needlesticklancet injuries and cuts from sharp objects that are contaminated with another persons blood or other potentially infectious. The center conducts epidemiological research, surveillance, and outreach on sharps injuries, needlesticks, blood, and body fluid exposures.
Needlesticks and other sharps injuries data and statistics. Documentation and identification of source individual pdf sample exposure control plan pdf statement of declination pdf hepatitis b immunization record pdf exposure incident report. The log must be retained for five years following the end of the year to which it relates. This log is to be maintained in such a way to protect the privacy of the employee, and the nau. Did the injury occur before the protective mechanism was dno dno activated, after it was activated, or during activation. This log must be kept in addition to the injury and illness log required by 29 cfr 1904. The log must include, at a minimum, the type and brand of.
Sharps injury log means a written or electronic record satisfying the requirements of subsection c 2. Workbook for designing, implementing, and evaluating a sharps. From the left hand side of page, select the point during or after use that most closely represents when the injury occurred. Fill free fillable farmingdale sharps injury log pdf form. Its work is fueled in part by its free occupational injury and exposure surveillance tool the exposure prevention information network epinet. Sharps injury log pdf request for source individual evaluation pdf. Bloodborne pathogens program directive pdf oregon osha resource page. Osha sharps injury log form fill online, printable. Sharps injury log template injury log template is related to general templates. Did the device have a sharps injury prevention feature, i.
Use fill to complete blank online state university of new york at farmingdale pdf forms for free. A7 sample blood and body fluid exposure report form page 4 of 5 c. Needle safety every year, ona members are exposed to deadly pathogens as a result of incidents from medical sharps devices. The most secure digital platform to get legally binding, electronically signed documents in just a few seconds. Strategies to reduce or eliminate the use of needles e. Although registered nurses sustain the majority of injuries, doctors, lab technologists, housekeeping staff, maintenance workers and other healthcare workers also suffer needlestick and sharps injuries. The log must be kept in a manner that preserves the confidentiality of the affected employee. A7 sample blood and body fluid exposure report form page 1 of 5. Prepare a baseline profile of sharps injuries and prevention.
Msu bbp exposure control plan appendix k revised sep2017 employee bloodborne pathogens exposure involving a sharp. D before d after d during if the sharp did not have engineered sharps injury protection, the employee should give an opinion as to whether and. To record details of all exposure incidents that involve a. The sharps injury log should include all sharps injuries occurring in a calendar year. A sharps injury log has been established and maintained as a record in either written or electronic form ofeach expo sure incident involving a sharp.
The log must be retained for five 5 years following the end of the year to which it relates. A sharps injury log, which is a record of each exposure incident involving a sharp, must be maintained by the employer. Fill online, printable, fillable, blank farmingdale sharps injury log form. California code of regulations, title 8, section 5193.
Additionally, employers must keep a record of each incident that appears on the log, using the osha form 301, injury and illness incident report, or the workers compensation first report of injury form. Californias employer records of occupational injury and. Oct 01, 2015 additionally, employers must keep a record of each incident that appears on the log, using the osha form 301, injury and illness incident report, or the workers compensation first report of injury form. Our policy is to maximize the utility ofthe sharps injury log by.
The log is a valuable surveillance tool for healthcare facilities to identify departments, devices, andor procedures where injuries are occurring. Sharps injury log the supervisor is to complete a log for each personnel exposure to blood or other opim incident involving a sharp. Prevention act signed into law in november, 2000 link to pdf file authorized oshas. Free printable visual learning guides for safe sharps disposal. The log must be kept in a manner that preserves the confidentiality of the affected. Here you will find the workbook for designing, implementing and evaluating a sharps injury prevention program, which has been developed by cdc to help healthcare facilities prevent needlesticks and other sharpsrelated injuries to health. Start a free trial now to save yourself time and money. Specific information about the incident must be recorded within 14 days after being reported. Can the calosha 300 log and 301 form be used to meet the calosha bloodborne pathogen standards requirement for a sharps injury log under t8ccr 5193.
The sharps injury log is used to track devices that are causing injuries and may need to be replaced. Maintain a sharps injury log to track the type and brand of device used, the department or area where the incident occurred, and an explanation of the incident. Procedures for maintaining employee confidentiality must be followed. Fill out, securely sign, print or email your sharps injury log form instantly with signnow. Employers must maintain a log of injuries from contaminated sharps 29 cfr 1910. Hands free transfer disposable magnetic drapes sharps counting and disposal system magnetic floor sweep scalpel blade removal system. This log is to be maintained in such a way to protect the privacy of the employee, and the nau sharps injury log is located at campus health services. Sharps injury log must include all sharps injuries occurring in a calendar year. The fda collaborated with kwikpoint under a cooperative research and development.
Sharps injury logs are intended to track departments, devices. Osha form 300, 300a, and 301 for logging and reporting injuries. Oshas bloodborne pathogens standard, 1910,1030, requires an employer to establish and maintain a sharps injury log for recording all percutaneous injuries. Additional factors with a negative impact on safe handling were healthcare worker hcw fatigue, uncooperative patients, or teams. Sharps injury control program sharps department of health services, occupational. The key elements of this log are an identification of the product being used by type and brand, the work area where. Bloodborne pathogens resources oregon department of. The log must be kept in addition to the injury and illness log required by 29 cfr 1904. It is known, that most exposures occur within the patient room, followed by operating room and the emergency department see figure 5.
Following a percutaneous injury from a contaminated sharp, the employee or employees supervisor must record the necessary information in the table above. Once completed you can sign your fillable form or send for signing. Sharps injury logs are intended to track departments. Sharps injury control program sharps department of health services, occupational health branch. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Sign, fax and printable from pc, ipad, tablet or mobile with pdffiller instantly.
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