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Mock exposure event - incident report

incident report
Academic year: 2020/2021
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Carrington College

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MA104 WK

XII.P. Participate in a Mock Exposure Event with Documentation of Specific

Steps

MAERB Core Curriculum

III.P Participate in blood-borne pathogen training XII.P Participate in a mock exposure event with documentation of specific steps

Task: To provide documentation required by OSHA in the event an employee becomes injured or is exposed to blood or body fluids. A post-exposure plan must be followed, and an incident report must be filled out.

Supplies & Conditions: OSHA Form 301 (Injury and Illness Incident Report), pen.

Standards: A maximum of three attempts may be used to complete the task. The time limit for each attempt is 15 minutes, with a minimum score of 70 percent. Scoring: Determine student’s score by dividing points awarded by total points possible and multiplying results by 100.

Forms: Procedure 34–1 Scenario with Procedure 34–1 Form. Procedure forms can be downloaded from the Student Companion website; procedure scenarios are included in the Instructor’s Manual.

EVALUATION

Evaluator Signature: Date:

Evaluator Comments:

Student Signature: Date:

Start Time: End Time: Total Time:

Steps Possible Points

First Attempt 100%

Second Attempt 80%

Third Attempt 70%

  1. Report the incident to a supervisor immediately for documentation.

5.

  1. Assemble equipment. 5.

  2. Fill in the demographic information about the employee. 5.

  3. Fill in the information about the physician or other health care professional.

5.

  1. Complete the section regarding information about the case.

5.

  1. Fill in what the employee was doing just before the incident occurred.

5.

  1. In the space provided, explain what happened. 5.

  2. Explain what the injury or illness was. 5.

  3. Explain what object or substance directly harmed the employee.

5.

  1. If the employee died, fill in the section concerned with when the death occurred.

5.

Points Awarded / Points Possible 59 _____/ 59

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Mock exposure event - incident report

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MA104 WK2
XII.P.4. Participate in a Mock Exposure Event with Documentation of Specific
Steps
MAERB Core Curriculum
III.P.1 Participate in blood-borne pathogen training
XII.P.4 Participate in a mock exposure event with documentation of specific steps
Task: To provide documentation required by OSHA in the event an employee becomes injured or is
exposed to blood or body fluids. A post-exposure plan must be followed, and an incident report
must be filled out.
Supplies & Conditions: OSHA Form 301 (Injury and Illness Incident Report), pen.
Standards: A maximum of three attempts may be used to complete the task. The time limit for each attempt is
15 minutes, with a minimum score of 70 percent. Scoring: Determine student’s score by dividing
points awarded by total points possible and multiplying results by 100.
Forms: Procedure 34–1 Scenario with Procedure 34–1 Form. Procedure forms can be downloaded from the
Student Companion website; procedure scenarios are included in the Instructors Manual.
EVALUATION
Evaluator Signature: Date:
Evaluator Comments:
Student Signature: Date: