Exposure to blood and bodily fluids report form

If staff are at risk of contact with blood or bodily fluids, then you’ll need to be ready to respond. Our form will help you to record the details of what happened, to whom and the follow-up actions taken.

When to use the form

Whilst you take the precautions you can to avoid staff coming into direct contact with blood and other bodily fluids, there’s always a risk if they are involved in caring professions, first aid, or carry out cleaning, waste management or even maintenance.

The form should be used to record the details of needlestick injuries or other instances of exposure to blood or bodily fluids. It does not need to be completed if there was no direct contact with the contaminant, e.g. due to the wearing of gloves, aprons, masks etc.

What’s covered?

The details collected should be treated confidentially as they involve sensitive health information and personal data. The form covers:

• incident location, date and time

• details of the individual exposed, including their GP details and whether they believe they carry current immunisation against Hepatitis A or B

• incident details, i.e. the fluid involved, injury information, protective clothing worn, incident description

• source details - if known, the name, address etc. of the individual who was the source of the bodily fluid

• follow-up and investigation, including who the member of staff was referred to and any actions identified to prevent a recurrence.