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safety

Bloodborne Pathogen Exposure Report

OSHA 29 CFR 1910.1030 BBP exposure report — needlestick / body fluid exposure documentation.

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Rolled out to every employee at AutoZone (125,000), PetSmart (50,000+), A.S. Watson and Raley's (20,000) — and at larger retailers we are not permitted to name.

Built for: Healthcare · Lab · Dental

What's inside this template

Exposure Event

  • Date and time of exposure (required)
  • Location (unit / room) (required)
  • Type of exposure (required)

    Needlestick / Other sharps / Mucosal splash / Non-intact skin contact

  • Body site exposed (required)
  • Source of exposure (device / activity) (required)

Source Patient

  • Source patient identifier (required)
  • Source patient consent for testing obtained? (required)
  • Source patient HIV / HBV / HCV status if known

Exposed Employee

  • Employee name (required)
  • Job title / role (required)
  • HBV vaccination status

    Vaccinated / Declined / Unknown

  • PPE in use at time of exposure

Response

  • Time to reach occupational health (must be ≤2 hr for HIV PEP eligibility) (required)
  • PEP recommendation made
  • Reporter signature (required)

Common use cases

Needlestick / sharps exposure
Mucosal splash exposure

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Start free — included with every suite

Rolled out to every employee at AutoZone (125,000), PetSmart (50,000+), A.S. Watson and Raley's (20,000) — and at larger retailers we are not permitted to name.