Bloodborne Pathogens Incident ReportBloodborne Pathogens Incident Report Exposed Person Name * Exposed Person Title Date of Incident * Spoon River College Address Spoon River College Address Spoon River College Address Spoon River College Address City City State/Province State/Province Zip/Postal Zip/Postal Description of Incident * Was the Hepatitis B Vaccination Series and Medical Evaluation offered to the exposed person? * Yes NoWas clothing or other laundry exposed to “OPIM”? * Yes NoDoes clothing or other laundry require disposal? * Yes No**If no, owner of contaminated laundry must complete this release.Did the exposed person decline treatment? * Yes No This report was completed by: * If you are human, leave this field blank. Next
