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Sonoran University of Health Sciences

BLOOD-BORNE PATHOGEN EXPOSURE REPORTING FORM

This form should be completed by the Exposed Individual or the Attending Physician or Resident involved, immediately following a possible blood-borne pathogen exposure.  A copy will automatically be submitted to the Clinics Safety Officer.
 
Banner Occupational Health Services, 602-747-8364 must be called within 15 minutes of possible exposure, identify self from Sonoran University of Health Sciences.
 
*In the case of an Injury (including needle stick): If the exposed individual is a Sonoran University employee, you are required to submit the Worker’s Report of Injury Form to ADOSH within 1 year of the exposure.  https://www.azica.gov/forms/claims0407 
 
*In the case of a needle stick or other puncture stick: you must also submit an incident form: https://scnm.questionpro.com/t/AO4M2ZpnEA