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Bloodborne Pathogen Exposure Control Plan

I. Purpose

The purpose of this plan is to bring Montana Tech into compliance with the Montana

Occupational Safety and Health Act (50-71-111-123 MCA and 24.30.102 ARM) and the OSHA

Bloodborne Pathogen Standard (29 CFR 1910.1030). The Montana Tech written exposure

control plan is designed to protect employees from possible infection caused by bloodborne

pathogens including, but not limited to, Human Immunodeficiency Virus (HIV), Hepatitis B Virus

(HBV), and Hepatitis C Virus (HCV).

See Appendix A for definitions

II. Responsibilities

Department Heads, Program Managers – Department heads and program managers are

responsible for carrying out the Bloodborne Pathogens Exposure Control Plan in accordance

with these written procedures and the General Guidelines and Standard Operating Procedures

found in Appendix B. Department heads and program managers are responsible for reviewing

and approving the use of human materials in classrooms and teaching laboratories.

Departments are responsible for identifying employees who have a potential for occupational

exposure to bloodborne pathogens. Department heads and program managers must ensure

that employees arrange for a Hepatitis B vaccination through Pro-Med Services, the

Community Health Center, or a private physician. If an employee declines a vaccination,

department heads and program managers must have the employee complete the

vaccination declination form in Appendix C. Department heads and program managers must

also ensure that the identified employees are aware of this written program, provide for

appropriate training, and immediately notify the EH&S Director of any occupational exposure

incident.

The Bloodborne Pathogen Standard requires the employer to cover the cost of the hepatitis B

immunization. The immunization rider on the University health insurance plan currently covers

the cost for the immunizations. In the event that the immunization rider would no longer be

available, departments or programs would be responsible for the cost of the immunizations. If a

department employs students who have the potential for exposure to bloodborne pathogens,

the department is responsible for the cost of the immunization.

Employees – Employees are responsible for complying with procedures established by their

supervisors in accordance with this program to minimize the risk of exposure. Employees are

also responsible for informing their supervisors of any exposure after the incident.

Instructors – Instructors are responsible for identifying any activates in the classroom and

teaching laboratory programs they control which may involve the potential for exposure to

bloodborne pathogens. Instructors must obtain department approval for any new activities

And train their students in appropriate protection technique.

Office of Environmental Health and Safety (EH&S) - EH&S is responsible for administering and

managing the Bloodborne Pathogens Exposure Control Program, coordinating the disposal of

infectious waste materials, assisting departments in evaluating potential exposures and in

conducting employee training.

III. Exposure Determination

The Montana Occupational Safety and Health Act requires employers to perform an exposure

determination to ascertain which employees have the potential to incur an occupational

exposure to blood or other potentially infectious materials. The exposure determination is made

without regard to the use of personal protective equipment. This exposure determination must

list all job classifications in which employees may incur such occupational exposure, regardless

of frequency of potential. Montana Tech has determined the following job classifications to be

in this category. See Appendix D for a complete description.

 Nursing staff

 Athletic trainers

 Custodians

 Maintenance workers

IV. Compliance Methods

Universal Precautions or Standard Precautions will be observed by all Montana Tech personnel

to prevent contact with blood or other potentially infectious materials. According to the

concept of Universal Precautions, all blood and other bodily fluids are treated as if they are

potential sources of contamination.

General Guidelines and Standard Operating Procedures (Appendix B) must be followed at all

times.

V. Hepatitis B Virus Vaccination Program

OSHA regulations require employers to offer the HBV vaccine free of charge to employees in

job classifications where employees have the potential for occupational exposure to blood or

other body fluids. The vaccine must be offered within 10 working days of initial assignment to

the job.

Employees who choose not to accept the vaccine must sign the declination form found in

Appendix C indicating their decision. However, should the employee change his/her mind

about receiving the vaccine, he or she may still obtain the vaccine free of charge, provided

the employee still has the potential for occupational exposure to bloodborne pathogens.

Department heads and program managers are responsible for ensuring the vaccine is offered

and/or waivers are signed.

VI. Post-Exposure Evaluation and Follow-up

If an exposure occurs, the employee must report the incident to his/her supervisor or instructor

who will notify the EH&S Director. Work will begin to ascertain the source individual’s identity,

arrange for testing of the source individual, and communicate with the physician evaluating

the employee. The employee must complete an Exposure Incident Report (Appendix E) and

the First Report of Occupational Injury or Occupational Disease (link found on the EH&S website

and Personnel website). A copy of the Exposure Incident Report must be given to the

evaluating physician by the employee, and a copy will be maintained in the employee’s

confidential file in the EH&S Office.

VII. Post-Exposure Medical Evaluation

Following the report of an exposure, the exposed employee will immediately receive a

confidential medical evaluation and medical follow-up conducted by a licensed physician or

healthcare worker at no cost to the employee. See Appendix F for documentation that must

be submitted to the healthcare professional. The evaluation must include:

A. Documentation of the route of exposure and the circumstances under which the

exposure incident occurred.

B. Identification of the source individual, where possible and not prohibited by state or

local law.

C. HBV and HIV blood test results of the source individual as required, if feasible and after

consent is obtained, unless the source is already known to be infected with HBV or HIV.

If consent is not obtained, the healthcare provider will establish and document that

legally required consent cannot be obtained.

The exposed employee will be offered blood collection and/or testing. All required laboratory

tests must be done by an accredited laboratory at no cost to the employee. The employee

has the right to refuse either or both. However, if the exposed employee gives consent for

blood collection, but not for HIV testing, the blood is kept for 90 days. During this time the

employee can choose to have the sample tested.

Appropriate post-exposure prophylaxis is offered to the employee by the healthcare provider.

This includes immunoglobulin for Hepatitis B. The recommendations of an evaluating physician

who is familiar with current CDC guidelines on post-exposure prophylaxis treatment for HIV and

Hepatitis C are followed in the event of HIV or Hepatitis C exposure.

Counseling and evaluation of any reported illnesses are provided at no charge to the

exposed employee.

Results of the source individual’s blood test will be made available to the exposed individual in

accordance with state and local laws.

VIII. Written Opinion of Healthcare Professional

A written opinion by the evaluating healthcare professional is included in the employee’s

confidential medical record. The written opinion is made available to the exposed person

within 15 days of the completion of the evaluation.

The written opinion for post-exposure follow-up will be limited to the following information:

A. A statement that the employee has been informed of the results of the evaluation.

B. A statement that the employee has been told about any medical conditions resulting

from the exposure that require further evaluation or treatment.

The written opinion for the HBV vaccination will be limited to whether the HBV vaccination

series is indicated, and whether the employee has received that vaccination series.

NOTE: All other findings or diagnoses remain confidential and are not to be included in the

written report to the employer.

IX. Recordkeeping

The following recordkeeping procedures will be followed.

Medical Records - The medical records are kept for at least 30 years after the person leaves

employment. Medical records are confidential and are kept for all employees with

occupational exposure and must include:

 Employee's name and social security number

 Hepatitis B vaccination status, including dates of vaccinations, records relating to

employee's ability to receive the vaccine, and signed declination form where

applicable.

 All information given to the evaluating healthcare professional in the event of an

exposure incident.

 A copy of the evaluator's opinion.

Written permission is required for access to the employee's medical record.

The confidential medical records are kept in the Office of Environmental Health & Safety.

Employee medical records are available upon request to the Department of Labor Industry,

Safety Bureau.

X. Training

Training for all employees will be conducted prior to initial assignment to tasks where potential

occupational exposure may occur. See Appendix G for the required training information.

XI. Post Exposure Protocol

The sites listed below are equipped to provide post exposure evaluation and treatment to

employees of Montana Tech.

 Pro-Med Services

 St. James Healthcare Emergency Department

 Private physician

Employee MUST:

 Report an occupational exposure within 24 hours to his or her immediate supervisor, who

must immediately notify the EH&S Director.

 Complete “First Report of an Occupational Injury” and initiate the “Employee

Occupational Exposure Incident Form.”

 Go to one of the facilities listed above for treatment. Take the required documentation

to the appointment (see Appendix F). An exposure while on duty is considered a

Workers’ Compensation case if it meets the definition of an accident under the Workers’

Compensation Statute.

XII. Student Policy

See Appendix H for Montana Tech’s Bloodborne Pathogen Student Policy.

Updated December 2015

Appendix A: Definitions

The following definitions are provided to assist in the understanding of bloodborne pathogens and the

requirements of the OSHA Standard.

Blood: Human blood, human blood components and products made from human blood.

Bloodborne Pathogens: Microorganisms that are present in human blood and can cause disease in

humans. These pathogens include Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and Human

Immunodeficiency Virus (HIV).

Contaminated: The presence, or the reasonable anticipated presence, of blood or other potentially

infectious materials on an item or surface.

Decontamination: The use of physical or chemical means to remove, inactivate or destroy

bloodborne pathogens on a surface or item to the point where they are no longer capable of

transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal.

Engineering Controls: Control measures that isolate or remove the bloodborne pathogen hazard

from the workplace, including sharps disposal containers and self-sheathing needles.

Exposure Incident: When an employee has contact with blood or other potentially infectious

materials as a result of his or her duties. This contact includes specific eye, mouth, other mucous

membrane, non-intact skin, or parenteral contact.

Healthcare Provider: A person whose legally permitted scope of practice allows him or her to

independently perform the activities required to administer HBV vaccination and post-exposure

evaluation and follow-up.

HBV: Hepatitis B Virus – Causes an infection with symptoms of anorexia, malaise, nausea, vomiting,

abdominal pain, jaundice, and skin rashes. The infection can become chronic and progress to

cirrhosis of the liver and liver cancer.

HCV: Hepatitis C Virus –Causes a contagious viral disease characterized by inflammation of the liver,

and in many cases, permanent damage to the liver and death.

HIV: Human Immunodeficiency Virus – Attacks white blood cells called T-cells which are vital to the

immune system. A person infected with HIV becomes susceptible to contracting other opportunistic

diseases.

Non-intact Skin: Skin that has cuts, abrasions or other openings through which bloodborne

pathogens could enter the bloodstream.

Occupational Exposure: Reasonably anticipated employee contact with blood or other potentially

infectious materials that may result from the performance of an employee’s duties. This includes skin,

eye, mucous membrane or parenteral contact.

Other Potentially Infectious Materials (OPIM):

1. Human Body Fluids

 Semen

 Vaginal secretions

 Fluid in the joints (synovial fluid)

 Fluid surrounding the heart (pericardial fluid)

 Fluid that protects the fetus (amniotic fluid)

 Fluid in the brain and spinal cord (cerebrospinal fluid)

 Fluid in the lungs (pleural fluid)

 Abdominal fluid (peritoneal fluid)

 Saliva in dental procedures

 Any body fluid that is visibly contaminated with blood.

 All body fluids in situations where it is difficult or impossible to differentiate between body fluids.

2. Any unfixed tissue or organ (other than intact skin) from a human, living or dead.

3. HIV containing cell or tissue cultures, organ cultures, and HIV, HBV or HCV containing culture

medium or other solutions.

4. Blood, organs or other tissues from experimental animals infected with HIV, HBV, or HCV.

Parenteral: Puncture wounds to the mucous membranes or the skin barrier caused by needlesticks,

human bites, cuts and abrasions.

Personal Protective Equipment (PPE): Specialized clothing or equipment worn by an employee for

protection against a hazard.

Regulated Waste: Liquid or semi-liquid blood or other potentially infectious materials; contaminated

items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if

compressed; items that are caked with dried blood or other potentially infectious materials and are

capable of releasing these materials during handling; contaminated sharps; and pathological or

microbiological wastes containing blood or other potentially infectious materials.

Sharps: Any object that can penetrate the skin, including needles, scalpels, broken glass, broken

capillary tubes and exposed ends of dental wires.

Source Individual: Any individual, living or dead, whose blood or other potentially infectious materials

may be a source of occupational exposure to the employee.

Sterilize: The use of a physical or chemical procedure to destroy all bacteria.

Universal Precautions or Standard Precautions: An approach to infection control in which all human

blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, HCV and

other bloodborne pathogens.

Work Practice Controls: Controls that reduce the likelihood of exposure by changing the way a task is

performed.

Appendix B: Guidelines and Standard Operating Procedures

The following guidelines have been adopted by Montana Tech in order to simplify compliance with

the standards that govern bloodborne pathogens.

1. Handwashing – Employees are to wash their hands and any other potentially contaminated skin

with soap and potable water immediately or as soon as possible following contact with any

potentially infectious material. Mucous membranes (eyes, mouth, and nose) are to be flushed with

potable water immediately or as soon as possible after contact with potentially infectious material.

If you have an open wound, squeeze the wound gently until it begins to bleed, and then wash the

area with soap and water.

Where handwashing facilities are not available, an antiseptic cleaner in conjunction with clean

cloth/paper towel or antiseptic towelettes should be used. If antiseptic hand cleaners or

towelettes are used, the contaminated area is to be washed with soap and running potable water

as soon as possible after exposure.

Employees are to wash their hands with soap and water as soon as feasible after removal of

gloves. See number 8 in this section for additional information on wearing gloves.

2. Housekeeping – Any contaminated area must be cleaned and decontaminated after each time

that it is contaminated. Decontamination will be accomplished utilizing a 1:10 mixture of

household bleach to water. An EPA registered germicide may be used in place of the above

mixture. Instructions and precautions on the germicide label must be read and followed. All

contaminated work surfaces will be decontaminated after completion of procedures and

immediately, or as soon as reasonably feasible, after any spill of a potentially infectious materials,

as well as at the end of the work shift if the surface may have become contaminated since the last

cleaning. All bins, pails, cans, buckets, and similar receptacles must be inspected and

decontaminated on a regular basis. Any broken glassware that may be contaminated must not

be picked up directly with the hands, even if gloves are worn. Use mechanical means such as

tongs or a broom and dustpan to pick up glass (do not use a vacuum), and decontaminate the

area with a bleach solution and a mop; the use of paper towels creates a solid waste hazard.

Dispose of glass in a plastic puncture resistant container and place in a biohazard bag. A sharps

container may be substituted in place of this method of disposal.

3. Containers for Sharps – Contaminated sharps are to be placed into appropriate sharps containers

as soon as possible after use. Sharps containers must be puncture resistant, labeled with biohazard

label and be leak proof.

4. Work Area Restrictions – In areas where there is a reasonable likelihood of exposure to potentially

infectious materials, employees are not to eat, drink, apply cosmetics or lip balm, use tobacco

products, or handle contact lenses.

5. Needles – Contaminated needles and other contaminated sharps cannot be broken, bent, or

recapped. They must be placed in an appropriate sharps container.

6. Regulated Waste – All contaminated sharps must be discarded as soon as feasible in sharps

containers which must be easily accessible to personnel and as close as feasible to the immediate

area where the sharps are used. During use, containers for sharps will be maintained in an upright

position throughout use and replaced as needed to prevent overfilling. When moving containers

of contaminated sharps from the area of use, the containers must be closed immediately prior to

removal. Tape may be used to secure a lid, but cannot be used as the lid itself. If leakage is

possible, the sharps container must be placed in a sealable secondary container to prevent

leakage during handling, storage, transport or shipping. If outside contamination of the regulated

waste container occurs, it must be placed in a secondary container. Disposal of all regulated

waste must be in accordance with applicable regulations.

7. Labels – Warning labels must be affixed to containers of regulated waste or other potentially

infectious materials.

8. Personal Protective Equipment (PPE) – The use of PPE is mandatory when exposure to potentially

infectious materials is anticipated. All PPE will be provided at no cost to the employee. Gloves

must be worn where it is reasonably anticipated that employees will have contact with potentially

infectious material, non-intact skin, and mucous membranes. Gloves are available from the

custodial supervisor, the athletic trainer or course instructors. Gloves must be worn:

a. When direct care of a student or coworker may involve contact with blood or other

potentially infectious materials, non-intact skin, and mucous membranes.

b. When contact with urine, feces and respiratory secretions is anticipated.

c. When providing mouth, nose, or tracheal care.

d. If the caregiver has broken skin on the hands, including around the nails.

e. When cleaning up spills of blood, bodily fluids and wastes, and soiled supplies.

CPR shields should be used along with eye protection and gloves when administering CPR.

1300 W. Park Street | Butte, MT 59701 | mtech.edu | 406.496.4463

Appendix C: Hepatitis B Vaccination Declination

I, the undersigned employee, understand that due to my potential for occupational exposure

to blood or other potentially infectious materials, I may be at risk of acquiring a hepatitis B

virus (HBV) infection. I have been given the opportunity to be vaccinated with hepatitis B

vaccine at no charge to me. However, I decline hepatitis B vaccination at this time. I

understand that by declining this vaccine, I continue to be at risk of acquiring hepatitis B, a

serious disease. If, in the future, I continue to have occupational exposure to blood or other

potentially infectious materials and I want to be vaccinated with hepatitis B vaccine, I can

receive the vaccination series at no charge to me at that time.

Employee Name (print) ______________________________________________

Employee Signature _________________________________________________ Date ______________

Employee Representative Signature __________________________________ Date ______________

This document must be printed, signed, and sent to mcameron@mtech.edu or brought to EHS office CBB 003.

Appendix D: Potentially Exposed Employees

The following tables illustrate the tasks and situations that employees are subjected to that could

potentially contribute to an exposure to bloodborne pathogens.

Job classification

Work Task

Exposure Situation

Nursing Staff and Students

Handling patients

Contact with blood or other bodily

fluids.

Handling syringes and needles

Accidental self-inoculation and

needle-sticks.

Handling vials, other containers of blood

and bodily fluids

Breakage of containers may lead to

contact with blood and other bodily

fluids.

Working with medical handpieces and

equipment containing blood or bodily

fluids

Cuts and pricks from equipment;

contact with infectious materials from

spills, splashes, and routine equipment

handling procedures.

Collecting specimens of blood and

other bodily fluids

Accidental self-injection. Spillage of

fluids. Aerosol droplet contamination.

Preparing samples of blood or other

bodily fluids for microscopic examination

Cutting finger on sharp edges of

slide/cover slip. Exposure through

non-intact skin.

Testing specimens of blood, other bodily

fluids.

Accidental self-injection. Spillage of

fluids. Aerosol droplet contamination.

Pulmonary function test administration.

Aerosol droplet contamination

Administration of cardio-pulmonary

resuscitation (CPR)

Contact with saliva, open wounds of

the mouth, aerosol droplets

Cleaning and disposal of incontinent

stool, urine, emesis

Contact with bodily fluid, accidental

spillage

Athletic Trainers

Handling patients.

Contact with blood or other bodily

fluids

Use of scalpel and needles for debriding

calluses.

Contact with blood or other bodily

fluids

Environmental Health and

Safety Director

Responding to accidents, possibly

handling victims.

Contact with blood and other bodily

fluid.

Campus Security

Responding to accidents, possibly

handling victims.

Contact with blood and other bodily

fluids.

Custodian and

Maintenance Personnel

Cleaning sinks, toilets, other bathroom

fixtures.

Contact with blood and other bodily

fluids.

Removal of waste.

Contact with feminine sanitary items

and other potentially contaminated

materials. Handling disposed syringe

needles and other potentially

contaminated sharps.

General site clean-up

Contact with disposed syringe

needles, disposed personal items,

and other potentially infectious

materials.

Clean-up of vomit, other bodily fluids.

Contact with potentially infectious

fluids and materials.

Director and Assistant

Campus Recreation*

Clean-up of vomit, other bodily fluids.

Contact with potentially infectious

fluids and materials.

*Campus Recreation personnel respond to incidents that involve first aid and clean-up of body fluids.

1300 W. Park Street | Butte, MT 59701 | mtech.edu | 406.496.4463

Appendix E: Employee Occupational Exposure Incident Form

Employee Name:

Employee ID #:

Date:

Department/building:

Job title:

Date of incident:

Date reported:

Type of exposure:

Human bite

Blood/body fluid splash

Open wound, scratch, or abrasions contaminated with blood/body fluid/urine/stool

Puncture or scratch from sharp object

Needle stick following venipuncture

Needle stick from IVP or VIPB

Needle stick following injection

Other (describe)____________________________________________________________________

Describe exposure incident in detail:

What actions were taken immediately following the incident?

What precautions were in use at the time of the incident?

Gloves Gown/apron Mask Eyewear CPR shield None Other (specify) ________________

Dates of HBV vaccinations:

Employee signature:

Date:

Supervisor signature:

Date:

Follow-up

Date

Employee referred to physician of choice

Seen by: Office ER Pro-Med Declined to be seen

Employee’s blood drawn? YES NO

Employee offered HIV testing? YES NO

Accepted Declined

This document must be printed after completion, signed, and sent to mcameron@mtech.edu or brought to EHS

office CBB 003.

Appendix F: Post-Exposure Documentation

In accordance with 29 CFR 1910.1030(f)(4)(ii)(A) through (E), the following documentation must be

provided to the healthcare professional evaluating an employee after an exposure incident:

 A copy of 29 CFR 1910.1030

 A description of the exposed employee’s duties as they relate to the exposure incident.

Appendix D, Employee Occupational Exposure Incident Form, meets this requirement.

 Documentation of the route(s) of exposure and circumstances under which exposure

occurred. Appendix D, Employee Occupational Exposure Incident Form, meets this

requirement.

 Results of the source individual’s blood testing, if available: and

 All medical records relevant to the appropriate treatment of the employee, including HBV

vaccination status, which are the employer’s responsibility to maintain.

Appendix G: Training

The following information is required information for training:

A. Information regarding the standard and an explanation of its requirements;

B. A general explanation of the epidemiology and symptoms of bloodborne diseases;

C. An explanation of the modes of transmission of bloodborne diseases;

D. An explanation of the employers’ exposure control plan or policy and the means by which

the employee can obtain a copy of the written policy;

E. An explanation of the appropriate methods for recognizing tasks and other activities that

may involve exposure to blood and other potentially infectious materials;

F. An explanation of the use and limitations of methods that will prevent or reduce exposure

including appropriate engineering controls, work practices, and personal protective

equipment;

G. Information on the types, location, proper use, and disposal of personal protective

equipment;

H. Information on the Hepatitis B vaccine, including its efficacy, safety, method of

administration, the benefits of being vaccinated, and that the vaccine is offered, pre- and

post- exposure, free of charge;

I. Information on the appropriate actions to take and persons to contact in an emergency

involving blood or other potentially infectious materials;

J. An explanation of the procedure to follow if an exposure occurs, including the method of

reporting the incident and the medical follow-up that will be made available;

K. An explanation of the signs and labels and/or color coding required;

L. Information on the post-exposure evaluation and follow-up that the employer is required to

provide for the employee following an exposure incident;

M. An opportunity for interactive questions and answers with the person conducting the

training.

Appendix H: Bloodborne Pathogen Student Policy

I. Purpose

Students in any academic, research, or occupational program at Montana Tech of the

University of Montana who are at risk for bloodborne pathogen exposure are required to

present documentation of serologic evidence of immunity to hepatitis B (HBV), either by

vaccination or previous infection. Students who cannot meet this requirement for legitimate

religious or medical reasons must have their case reviewed by the Montana Tech Biohazard

Committee on an individual basis. If the Committee grants a waiver, they must do so in writing

prior to the student’s acceptance into the clinical component of the nursing program. In other

departments, the waiver must be granted in writing prior to the student’s first potential exposure

to human blood or other potentially infectious materials. Records of the waiver must be kept in

the students’ files within the department that is requiring the immunization.

II. Procedure

A. Students who are unable to meet the requirements of documentation of immunity for

religious or medical reasons must provide written documentation of the reasons which

preclude immunization for review by the Biohazard Committee. Request for review by the

Biohazard Committee must be made prior to application for admittance into the nursing

program. For other departments, the request for review must be made at least two weeks

prior to the first potential exposure to human blood or other potentially infectious materials

to allow time for resolution.

B. Effective June 1999, students are required to present the following information prior to

admittance into the nursing program, or in other departments, prior to their first potential

exposure to human blood or other potentially infectious materials. Students will not be

allowed in areas or settings which may present their first potential exposure to human blood

or other potentially infectious materials without this documentation.

1. Documentation of serologic immunity; or

2. Documentation of immunization series; or

3. Signed waiver of exemption from immunization requirements

III. Exposures

A. If a student has an exposure (i.e. eye, mouth, mucous membrane, non-intact skin, or

parenteral contact with blood or potentially infectious materials) in a setting sponsored by

Montana Tech, the student must follow the policy of the facility where they are working.

The student is responsible for the cost of post-exposure testing. Students can go to the

Student Health Center, the Family Service Center in Butte, or a private physician for testing

and counseling. Records of the exposure and follow-up must be kept in a confidential file in

the Environmental Health and Safety office.

B. If a student has an exposure, the student must report it immediately to the instructor or

supervisor. A Student Exposure Incident Form must be completed by the student, signed by

the student and instructor or supervisor, and sent to the Environmental Health and Safety

Director.

IV. Training

Student training must be done prior to the student’s first potential exposure to bloodborne

pathogens. The training must include the requirements of the Bloodborne Pathogen Standard,

universal precautions, and the Montana Tech policy. The training may be incorporated into

class materials or done through training provided by the Office of Environmental Health and

Safety.

1300 W. Park Street | Butte, MT 59701 | mtech.edu | 406.496.4463

Student Exposure Incident Form

Student Name:

Student ID #:

Date of incident:

Department/building:

Date Reported:

Type of exposure:

Human bite

Blood/body fluid splash

Open wound, scratch, or abrasions contaminated with blood/body fluid/urine/stool

Puncture or from sharp object

Needle stick following venipuncture

Needle stick from IVP or VIPB

Needle stick following injection

Other (describe)____________________________________________________________________

Describe exposure incident in detail:

What actions were taken immediately following the incident?

What precautions were in use at the time of the incident? Check all that apply

Gloves Gown/apron Mask Eyewear CPR shield None Other (specify) ________________

Dates of HBV vaccinations:

Employee signature:

Date:

Instructor/Supervisor signature:

Date:

Signature of person preparing report:

Date:

Follow-up

Date

Student referred to physician of choice

Seen by: Office ER Pro-Med Student Health Center

Declined to be seen

Other comments:

This document must be printed after completion, signed, and sent to mcameron@mtech.edu or brought to EHS

office CBB 003.

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