Blood and Body Fluid Exposure Protocol         

(Applies to Surgical Specimens and Autopsies)

Required forms

At least three forms will need to be filled out on the day of or by the next business day, if incident occurs on a non-business day.  (These forms are kept on record for 30 years.)  Print the forms (pdf format) and fill them out.

1.  One or two of the following forms:

• "University of Tennessee Report of an Occurrence" (one page) if a traumatic injury, ie. sprained ankle

• "Blood and Body Fluid Exposure Report" (two pages) if an exposure to blood and/or body fluid or "Needlestick and Sharp Object Injury Report" (three pages) if due to a needle stick or scalpel puncture or other sharp object.  In some cases involving a needle or scalpel that has blood or body fluids from the patient, ie. a "used" needle or scalpel, then this form in addition to the "Blood and Body Fluid Exposure Report" form will need to be filled out

• "Tennesseee Department of Labor and Workforce Development, Employer's First Report of Work Injury or Illness" (one page) and return it to Dale.

2.   "Supervisor's Report of Employee Accident" (one page) and you may have to help fill it out.  It also needs to be signed by the supervisor of the rotation, usually the attending.

3.    "Accident Report State of Tennessee Division of Claims Administration" (two pages)  To be filled out by you in case the event will need to be covered by workman's comp.  After it is completed by you and the supervisor, make sure to return it to Ms. Karen Weatherly at office phone no. 448-5577 on the same or the next business day.  It is mandatory that this form be filled out within 24 hours or by the next business day.