Biological Hazard Exposure Incident Form
Date of Incident
Time of Incident
Name of Person Reporting
Position/Title
Department/Unit
Location of Incident
Name(s) of Exposed Individual(s)
Type of Biological Hazard
Description of Incident
Route of Exposure
Percutaneous (needle/sharp injury)
Mucous membrane
Inhalation
Ingestion
Other
Personal Protective Equipment (PPE) Used
Immediate Action Taken
Was medical attention sought?
Yes
No
Follow-up/Recommendations