Infection Prevention Manual

EXPOSURE CONTROL PLAN BLOODBORNE PATHOGENS TRAINING/EDUCATION DOCUMENTATION FORM DATE(S) OF SESSION : INSTRUCTOR NAME: JOB TITLE: EMPLOYEE NAME: JOB TITLE: CONTENT OF TRAINING AND EDUCATION: Location of copy of Occupational Safety & Health Administration’s Occupational Exposure to Bloodborne Pathogens and explanation of contents General explanation of epidemiology and symptoms of bloodborne diseases Explanation of bloodborne diseases transmission modes Agency Exposure Control Plan, Infection Control, and Administrative Policies and Procedures location and contents Explanation of appropriate methods for recognizing tasks and other activities that may involve exposure to blood or other potentially infectious materials Explanation of the use and limitations of methods that will prevent or reduce exposure involving engineering controls, work practices, and personal protective equipment Information on the Hepatitis B vaccine to include it efficacy, safety, method of administration, and the benefits of being vaccinated. The vaccine shall be offered free of charge. An explanation of the biomedical labeling and/or color coding required by law Additional information covered: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ I acknowledge that I have been provided with training and education on occupational exposure to bloodborne pathogens and have understood the material presented, and that I have been given the opportunity for interactive questions and answers with the instructor. Employee Signature: __________________________________ Date:_____________ Your Agency Name (PN System)