Laboratory Sharps Injury Report
Employee Information
Name
Position/Title
Department/Lab
Date of Report
Incident Details
Date of Injury
Time of Injury
Location of Incident
Type of Sharp Involved
Description of Incident
Circumstances Leading to Injury
Exposure Details
Material Involved (Chemical/Biological)
Did the Sharp Appear Contaminated?
Yes
No
Personal Protective Equipment Used
Post-Incident Actions
First Aid Provided
Medical Attention Sought
Supervisor Notified
Date/Time Notified
Additional Comments