Biological Exposure Incident Report
Name of Exposed Individual
Job Title/Position
Date of Incident
Time of Incident
Location of Incident
Biological Agent Involved
Description of the Incident
Route of Exposure
Needle-stick
Cut
Splash to mucous membrane
Inhalation
Other
Personal Protective Equipment Used
Immediate Actions Taken
Medical Attention Sought
Yes
No
Supervisor Notified
Yes
No
Further Comments/Follow-up Required