Bloodborne Pathogen Exposure Investigation

Post-exposure investigation form for needlestick or body fluid exposure incidents.

Exposure Event

• Date of exposure
  When the exposure occurred.
• Time of exposure
  Approximate time the exposure occurred.
• Type of exposure
• Where did the exposure occur?
  Location or unit where the incident occurred.
• Describe what happened
  Brief factual description of the incident, including what task was being performed and how the exposure occurred.
• Was appropriate PPE worn?
• Immediate action taken

Exposure Details

• Route of exposure
• Device or item involved
  For example: hollow-bore needle, scalpel, broken glass, contaminated dressing.
• Was the device used on a patient or source?
• Fluid or material involved
• Exposure severity

Source Information

• Is the source known?
• Source type
• Source identifier
  Use an internal identifier or initials if permitted by policy; do not enter full identifiers unless required by your process.
• Source testing status
• Are source test results available?

Exposed Person Follow-up

• Was the exposed person notified of next steps?
• Was a medical evaluation completed?
• Evaluation date
• Post-exposure prophylaxis offered or provided?
• Work restrictions or follow-up instructions
  Document any temporary restrictions or follow-up instructions from occupational health.

Corrective Actions and Review

• Contributing factors
• Corrective actions
  Describe actions to prevent recurrence, such as training, device changes, or process updates.
• Reported to
• Reviewer name
  Name of the person completing the investigation review or approval.
• Review date