Bloodborne Pathogen Exposure Report

OSHA 29 CFR 1910.1030 BBP exposure incident report. Required documentation for needlestick and other body-fluid exposures, triggering source-patient testing and post-exposure prophylaxis.

Incident Details

• Date of exposure
• Time of exposure
• Location of exposure
• Type of exposure
• Brief description of what happened
  Describe the event factually. Include the task being performed and how the exposure occurred.

Exposure Route and Body Area

• Body area exposed
• Was a sharps device involved?
• Type of sharps device
• Was PPE worn at the time?

Source Material and Source Patient

• Is the source person or source material known?
• Source type
• Source testing status
• Source test result summary

Immediate Response and Medical Follow-Up

• Immediate first aid performed
• Reported to supervisor or charge person?
• Was a medical evaluation completed?
• Post-exposure prophylaxis (PEP) status
• Follow-up instructions provided
  Summarize any return-to-work, lab testing, counseling, or follow-up instructions given.

Reporter and Review

• Reporter name
• Reporter role
• Contact email
  Optional. Provide only if needed for follow-up communication.
• Additional notes