An important component of a bloodborne pathogen program are specific forms.

Forms for a BBP program

  • Receipt of Bloodborne Pathogen Plan: this form is used to document training of the employees, and to document that employees that face potential exposure have been provided with the bloodborne pathogen program. It is required to provide all employees that face potential exposure with a copy of the plan.
  • Hepatitis B Vaccine Record: As part of a bloodborne pathogen program, employees are required to be offered a hepatitis B vaccine. If employees opt to accept the vaccination, the employer should document the process. These records must be handled confidentially.
  • Declination of Hepatitis B vaccine form: As part of a bloodborne pathogen program, employees are required to be offered a hepatitus B vaccine. Some employees may decline this vaccine, and as such, this declination should be documented as proof that employees were offered the vaccine.
  • Exposure Documentation: In the event that an employee becomes exposed to a bodily fluid, it should be documented thoroughly, as quick response is important for the safety of the employee.

All of these forms should be maintained as part of the records associated with a quality bloodborne pathogen program.

Do not store these records in an employee’s personnel file with HR, as these forms are medical documentation, and mixing them with personnel records can create an issue of employee confidentiality. These records should be maintained in a separate area, with controlled access, to maintain employee record confidentiality.

Forms and programs are not the end point of protecting employees. It starts with ensuring that employees use universal precautions and proper PPE to minimize exposure potential. Always keep that at the forefront of all things associated with a bloodborne pathogen program.

Members view and download the bloodborne pathogen forms below

View and download the receipt of BBP exposure control form below

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View and download the Bloodborne Pathogen vaccine recordkeeping form below

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View and download the Bloodborne Pathogen vaccine declination record below

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View and download the Bloodborne Pathogen exposure control form

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