Sample occupational sharps injury log addendum a supplement. Safe sharps disposal label for recycling container pdf 460kb safe sharps disposal medication insert pdf 2. Osha forms for recording workrelated injuries and illnesses. Compliance officers can determine if training or use of proper personal protective equipment could have prevented the injury. The log must be kept in a manner the preserves the confidentiality of the affected. What action has or needs to be taken to prevent recurrence. Forms 300, 300a, 301 and instructions pdf fillable format. Medical facilities checklist pdf osha sharps device list. Start a free trial now to save yourself time and money. The information in the sharps injury log shall be recorded and maintained in such manner as to protect the confidentiality of the injured employee. The purpose of the log is to prevent future incidents from occurring. Osha injury and illness recordkeeping and reporting. Sharps injury log year 2 portland community college. Our policy is to maximize the utility ofthe sharps injury log by filling out the information as completely as possible in easytounderstandlanguage.
The sharps injury log should include all sharps injuries occurring in a calendar year. When an incident occurs, use the osha 300 log to record specific details about what. Sign, fax and printable from pc, ipad, tablet or mobile with pdffiller instantly. The employees opinion about whether any other engineering, administrative or work practice control could have prevented the injury. Needlesticks and other sharps injuries data and statistics. If the sharp did not have an engineered sharps injury protection, the injured employees opinion as to whether and how such a mechanism could have prevented the injury. A sharps injury log has been established and maintained as a record in either written or electronic form ofeach expo sure incident involving a sharp. A sharps injury log, which is a record of each exposure incident involving a sharp, must be maintained by the employer. Date and time department position location of incident body part injured device type device brand how injury occurred device had protective mechanism. Location where incident occurred click here to enter text.
Sharps injury log oshas bloodborne pathogens standard, 1910,1030, requires an employer to establish and maintain a sharps injury log for recording all percutaneous injuries in a facility occur ring from contaminated sharps this log and the injury andillness log required by 29 cfr 1904 must be retained by the employer. Occupational sharps injury log addendum a supplement to osha 300 and 301 forms insert your organizations confidentiality statement, instructions for completing log and obtaining medical care here. What acts or failures to act andor conditions contributed to this incident. Procedures for maintaining employee confidentiality must be followed. Injury log for recording all percutaneous injuries occurring from contaminated sharps. The log must be kept in a manner that preserves the confidentiality of the affected employee.
Sharps injury log for university of north dakota, 2015. If injury occurred before the sharp was used for its original intended purpose, do not submit this form. All information is required as incomplete forms will be returned to your supervisor for completion. The log of workrelated injuries and illnesses form 300 is used to classify workrelated injuries and illnesses and to note the extent and severity of each case. Contaminated sharps injury reporting form please complete a form for each exposure incident involving a sharp. Uniform needlestick and sharp object injury author. Needlesticksharps safety and prevention the needlestick safety and prevention act pub. This regulatory required sharps injury log and the employee injury illness report forms on hospital intranet under forms must be completed for any employee incident involving a contaminated sharp.
The most secure digital platform to get legally binding, electronically signed documents in just a few seconds. Osha requires the recording all workrelated needle stick injuries and cuts from sharp objects that are contaminated with another persons blood or other potentially infectious material as defined by 29 cfr 1910. All injuries from contaminated needlesticks are required to be recorded on the osha log. The sharps injury log does not replace the sharps injury report. Specific information about the incident must be recorded within 14 days after being reported. Job title of employeestudent click here to enter text. The log must be retained for five years following the end of the year to which it relates. Organization sought to be best in class on all measures, including employee safety competing priorities. The requirement to establish and maintain a sharps injury log shall apply to any employer who is required to maintain a log. This regulatory required sharps injury log and the employee injuryillness report forms on hospital intranet under forms must be completed for any employee incident involving a contaminated sharp. Implementing, and evaluating a sharps injury prevention program 20 course instructs hospitals how to run a sharps disposal function. The type and brand of device involved in the incident, the department or work area where the exposure incident occurred, and. Enter your official contact and identification details.
You must record all workrelated needlestick injuries and cuts from sharp objects that are contaminated with another persons blood or other potentially infectious material as defined by 29 cfr 1910. When an incident occurs, use the log to record specific details about what happened. Fill out, securely sign, print or email your sharps injury log form instantly with signnow. Sharps injury log oshas bloodborne pathogens standard, 1910,1030, requires an employer to establish and maintain a sharps injury log for recording all percutaneous injuries in a facility occur ring from contaminated sharps this log and the injuryandillness log required by 29 cfr 1904 must be retained by the employer. Did the injury occur before the protective mechanism was dno dno acttvated, after it was activated, or during acttvatlon. Fill in the one circle corresponding to the most appropriate answer. Please note that these forms are not designed for printing on standard 8. Is defined as an incident which occurs during a work activity and. An effective procedure for periodic determination of the frequency of use of the types and brands of sharps involved in the exposure incidents documented on the sharps injury log. This regulatory required sharps injury log and the employee injury illness report must be completed for any employee incident involving a contaminated sharp. This log must be kept in addition to the injury and illness log required by 29 cfr 1904. Osha sharps injury log form fill online, printable. O injury or illness resulting from a sexual assault o mental illnesses o hiv infection, hepatitis, or tuberculosis o needlestick injuries and cuts from sharps that are contaminated with another persons blood or opim o if the employee independently and voluntarily requests that his or her name not be entered on the log.
California code of regulations, title 8, section 5193. Sharps injury log template indiana state university. Our policy is to maximize the utility ofthe sharps injury log by. Injury occurred before, during or after activation of mechanism. According to osha, the best way to prevent cuts and sticks is to minimize contact with sharps. Injury rate injuries per 100 fte was the only metric reported to leadership. The purpose of the log is to aid in the evaluation of devices being used in healthcare and other. The advanced tools of the editor will guide you through the editable pdf template. An effective procedure for gathering the information required by the sharps injury log. Although participating hospitals vary in size, geographic location, and teaching status, the exposure patterns are surprisingly similar. The sharps injury log shall contain, at a minimum a the type and brand of device involved in the.
New jersey department of health peosh unit sharps injury log. D before d after d during if the sharp did not have engineered sharps injury protection, the employee should give an opinion as to whether and how such a mechanism could have prevented the injury. This log is to be maintained in such a way to protect the privacy of the employee, and the nau sharps injury log is located at campus health services. Sharps injury log template pdf fill out and sign printable. Several pages of the log but you may make as many copies of the log as you need. The way to complete the online sharps injury log template pdf on the internet.
Is this incident osha recordableon the sharps injury log. Yes if yes, was the protection mechanism activated. The log must be retained for five 5 years following the end of the year to which it relates. Sharps injury control program sharps department of health services, occupational health branch. Sharps injury and blood and body fluid exposure data from these healthcare facilities is collected on an annual basis, merged into an aggregate database, and analyzed using epinet reporting software. Because occupational exposure to bloodborne pathogens from accidental sharps injuries in healthcare and other occupational settings continues to be a serious problem, congress felt that a modification to. The log must be kept in a manner that preserves the confidentiality of the. Msu bbp exposure control plan appendix k revised sep2017 employee bloodborne pathogens exposure involving a sharp. Sharps injury log csuci bloodborne pathogen exposure program no copy to environment, safety, risk management 509 employee signature date did the sharp have an engineered injury protection mechanism. No personal employee identifiers are allowed in the log. Forms 300, 300a, 301 excel format forms only requires microsoft excel or equivalent. The sharps injury log should include all sharps injuries occurring in a calendar year and must be kept for five years following the end of the year to which it relates.
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