ATTACHMENT B

SHARPS EVALUATION AND SHARPS INJURY LOG

SHARPS EVALUATION

1.      Non-needle sharps and needle devices used for withdrawing body fluids, accessing a vein or artery, or administering medications or other fluids must have a built in safety feature that effectively reduces the risk of an exposure incident (i.e. needle stick).

2.      A committee must be established, which includes non-managerial employees responsible for direct patient care who are potentially exposed to injuries from contaminated sharps.

3.      This committee is to identify, evaluate and select needle and non-needle sharps with built in safety devices.

4.      This committee may select different devices for different job tasks. However, the employer (UA) is not required to provide different devices for each area with similar job tasks.

5.      If an employee is physically unable to use the selected device, the employer must provide a device that can be used.

6.      Committee minutes and decisions shall be documented.

7.      Interactive, hands on training shall be provided for employees who will use the selected devices. Training shall be documented.

Sharps Injury Log

Complete a Log record for each exposure incident involving a sharp. The exposure incident shall be recorded on the log within 14 working days of the date the incident is reported.

Institution:___________________________________  Building: ______________________

Address: ____________________________________  Date filled out: _________________

Filled out by _________________________________  Phone no. _____________________

As relates to the incident:

Name of person injured: _________________________________

Job title: _____________________________________________

Date of injury: _____________Time of injury: _______  Department ___________________

Room where injured: _________________________________

Type of sharp involved: _______________________________

Brand of sharp involved: ______________________________

Model:  ____________________________________________

(e.g. 18g needle/ABC Medical/"no stick" syringe)

Procedure being performed at the time of incident: ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

How the incident occurred: ___________________________________________________________________________

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________

The body part involved in the exposure incident: ____________________________________

Protective mechanism:

Was the sharp's protective mechanism activated? __________________

If applicable, did the injury occur :

      Before the mechanism was activated? _____

      During activation of the mechanism? ______

      After activation of the mechanism?  _______