Laboratory Biological Hazard Exposure Report
Date of Report
Reporter Name
Position/Title
Department/Lab
Date & Time of Exposure
Location of Incident
Biological Agent Involved
Description of Incident
Type of Exposure
Needlestick/Puncture
Inhalation
Spill/Splash
Contact with Broken Skin
Other
Personal Protective Equipment (PPE) Used
Actions Taken Following Exposure
Persons Notified
Witnesses
Additional Comments