Recording criteria for needlestick and sharps injuries. The sharps injury log should include all sharps injuries occurring in a calendar year and must be kept for five years following the end of the year to which it relates. The log must be kept in a manner that preserves the confidentiality of the affected employee. Fill in the one circle corresponding to the most appropriate answer. Sign, fax and printable from pc, ipad, tablet or mobile with pdffiller instantly. Uniform needlestick and sharp object injury author. Sharps injury log template indiana state university. Needlesticksharps safety and prevention the needlestick safety and prevention act pub. Sharps injury log for university of north dakota, 2015. Start a free trial now to save yourself time and money. Procedures for maintaining employee confidentiality must be followed.
Free printable visual learning guides for safe sharps. O injury or illness resulting from a sexual assault o mental illnesses o hiv infection, hepatitis, or tuberculosis o needlestick injuries and cuts from sharps that are contaminated with another persons blood or opim o if the employee independently and voluntarily requests that his or her name not be entered on the log. The log of workrelated injuries and illnesses form 300 is used to classify workrelated injuries and illnesses and to note the extent and severity of each case. Sharps injury log oshas bloodborne pathogens standard, 1910,1030, requires an employer to establish and maintain a sharps injury log for recording all percutaneous injuries in a facility occur ring from contaminated sharps this log and the injury andillness log required by 29 cfr 1904 must be retained by the employer. Osha forms for recording workrelated injuries and illnesses. Sharps injury log oshas bloodborne pathogens standard, 1910,1030, requires an employer to establish and maintain a sharps injury log for recording all percutaneous injuries in a facility occur ring from contaminated sharps this log and the injuryandillness log required by 29 cfr 1904 must be retained by the employer. An effective procedure for gathering the information required by the sharps injury log. All information is required as incomplete forms will be returned to your supervisor for completion. The most secure digital platform to get legally binding, electronically signed documents in just a few seconds. Sharps injury log template pdf fill out and sign printable. The employees opinion about whether any other engineering, administrative or work practice control could have prevented the injury. You must record all workrelated needlestick injuries and cuts from sharp objects that are contaminated with another persons blood or other potentially infectious material as defined by 29 cfr 1910.
Forms 300, 300a, 301 excel format forms only requires microsoft excel or equivalent. The purpose of the log is to aid in the evaluation of devices being used in healthcare and other. The sharps injury log does not replace the sharps injury report. Injury occurred before, during or after activation of mechanism. The type and brand of device involved in the incident, the department or work area where the exposure incident occurred, and. The sharps injury log should include all sharps injuries occurring in a calendar year.
The log must be kept in a manner that preserves the confidentiality of the. Enter your official contact and identification details. Sample occupational sharps injury log addendum a supplement. Osha requires the recording all workrelated needle stick injuries and cuts from sharp objects that are contaminated with another persons blood or other potentially infectious material as defined by 29 cfr 1910. This regulatory required sharps injury log and the employee injury illness report must be completed for any employee incident involving a contaminated sharp. Safe sharps disposal label for recycling container pdf 460kb safe sharps disposal medication insert pdf 2. Sharps injury log csuci bloodborne pathogen exposure program no copy to environment, safety, risk management 509 employee signature date did the sharp have an engineered injury protection mechanism. All injuries from contaminated needlesticks are required to be recorded on the osha log. The requirement to establish and maintain a sharps injury log shall apply to any employer who is required to maintain a log. When an incident occurs, use the log to record specific details about what happened. What action has or needs to be taken to prevent recurrence. An effective procedure for periodic determination of the frequency of use of the types and brands of sharps involved in the exposure incidents documented on the sharps injury log.
This log must be kept in addition to the injury and illness log required by 29 cfr 1904. Medical facilities checklist pdf osha sharps device list. When an incident occurs, use the osha 300 log to record specific details about what. California code of regulations, title 8, section 5193. This regulatory required sharps injury log and the employee injuryillness report forms on hospital intranet under forms must be completed for any employee incident involving a contaminated sharp. 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. Msu bbp exposure control plan appendix k revised sep2017 employee bloodborne pathogens exposure involving a sharp. Osha sharps injury log form fill online, printable. Because occupational exposure to bloodborne pathogens from accidental sharps injuries in healthcare and other occupational settings continues to be a serious problem, congress felt that a modification to. 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 how such a mechanism could have prevented the injury. Compliance officers can determine if training or use of proper personal protective equipment could have prevented the injury.
A sharps injury log, which is a record of each exposure incident involving a sharp, must be maintained by the employer. The log must be retained for five years following the end of the year to which it relates. Date and time department position location of incident body part injured device type device brand how injury occurred device had protective mechanism. Sharps injury control program sharps department of health services, occupational health branch. Did the injury occur before the protective mechanism was dno dno acttvated, after it was activated, or during acttvatlon. If injury occurred before the sharp was used for its original intended purpose, do not submit this form. Is defined as an incident which occurs during a work activity and. Several pages of the log but you may make as many copies of the log as you need. You must enter the case on the osha 300 log as an injury. Yes if yes, was the protection mechanism activated. If the sharp did not have an engineered sharps injury protection, the injured employees opinion as to whether and how such a mechanism could have prevented the injury.
Our policy is to maximize the utility ofthe sharps injury log by. Sharps injury log year 2 portland community college. The way to complete the online sharps injury log template pdf on the internet. This sharps injury log should include all sharps injuries occurring in a. Location where incident occurred click here to enter text. New jersey department of health peosh unit sharps injury log. Implementing, and evaluating a sharps injury prevention program 20 course instructs hospitals how to run a sharps disposal function. Osha injury and illness recordkeeping and reporting. The sharps injury log shall contain, at a minimum a the type and brand of device involved in the. The advanced tools of the editor will guide you through the editable pdf template.
Fill out, securely sign, print or email your sharps injury log form instantly with signnow. 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. Job title of employeestudent click here to enter text. The log must be retained for five 5 years following the end of the year to which it relates.
The purpose of the log is to prevent future incidents from occurring. Forms 300, 300a, 301 and instructions pdf fillable format. Is this incident osha recordableon the sharps injury log. Organization sought to be best in class on all measures, including employee safety competing priorities. Needlesticks and other sharps injuries data and statistics. The log must be kept in a manner that preserves the confidentiality of the affected. No personal employee identifiers are allowed in the log. Injury log for recording all percutaneous injuries occurring from contaminated sharps. 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. Please note that these forms are not designed for printing on standard 8. Injury rate injuries per 100 fte was the only metric reported to leadership. Sharps injury and blood and body fluid exposure data from these healthcare facilities is collected on an annual basis, merged into an aggregate database, and analyzed using epinet reporting software. The information in the sharps injury log shall be recorded and maintained in such manner as to protect the confidentiality of the injured employee.
Our policy is to maximize the utility ofthe sharps injury log by filling out the information as completely as possible in easytounderstandlanguage. Specific information about the incident must be recorded within 14 days after being reported. This regulatory required sharps injury log and the employee injury illness report forms on hospital intranet under forms must be completed for any employee incident involving a contaminated sharp. What acts or failures to act andor conditions contributed to this incident. According to osha, the best way to prevent cuts and sticks is to minimize contact with sharps. Although participating hospitals vary in size, geographic location, and teaching status, the exposure patterns are surprisingly similar. The log must be kept in a manner the preserves the confidentiality of the affected.
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