Bloodborne Pathogen Incident (Accident) Report
Form Template
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Bloodborne Pathogen Incident (Accident) Report mobile app to describe the incident in complete detail (route of exposure, circumstances; describe type of controls in place at time of incident including engineering controls and personal protective equipment worn; identify unsafe conditions and/or actions; relevant police reports). Note: A “source consent” form should be sent by the employee’s treating physician to the source or his/her medical provider to attempt to obtain permission for source HIV/HBV blood testing. The medical evaluator has been informed as to our policy and the OSHA rules. All medical data is confidential. All GoCanvas apps can be made HIPAA Compliant.
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