Page 212 - Safety Memo
P. 212

EXPOSURE INCIDENT INVESTIGATION REPORT

           Date of Incident:                                  Time of Incident:

           Exact Location:






           Potentially Infectious Materials Involved:






           Type:                                              Source:

           Circumstances:








           How Incident Was Caused:








           Personal Protective Equipment Being Used:








           Actions Taken:








           Recommendations for Avoiding Repetition:








           Safety Manager Completing Report:






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