CHECKLIST
Information Provided to the Healthcare Professional
The following items must be provided to the healthcare professional who will be evaluating the exposed individual. This section shall be used as a checklist to ensure all documentation is completed and forwarded to the healthcare professional. A copy of the Blood borne Pathogens Standard A copy of this Exposure Incident Report Employee vaccination status—documentation attached. Description of exposed student/faculty’s duties as they relate to the exposure incident Documentation of the route(s) of exposure and circumstances under which the exposure occurred. Results of source individual’s blood testing Other pertinent medical records
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Name of Healthcare Professional
Department/Clinic
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Dental Hygiene Program
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