Laboratory Animal Bite Incident Report

General Information

Date of Incident Time of Incident Location of Incident Name of Person Bitten Job Title Supervisor Contact Information

Animal Information

Species Strain/Breed/ID Were hazardous agents present? (e.g. infectious agents, hazardous substances) Yes No If yes, specify

Incident Description

Description of the Incident (include events leading up to the bite) Description of Bite/Exposure (location on body, severity) Personal Protective Equipment (PPE) Used

Post-Incident Actions

First Aid Provided Was medical evaluation sought? Yes No Report made to supervisor? Yes No Other actions taken

Follow-Up

Follow-Up Actions Planned Additional Comments Report Completed By Date