All of the reporting forms used by the Needlestick Injury Prevention Program have been revised for use beginning with January 1, 2010 injuries. Please be sure to use the correct forms when reporting 2010 injuries.
Reporting Instructions (Revision Date: 01/01/2010)
Individual Needlestick and Sharp Object Injury Report (Revision Date: 11/2009)
Use for printing to complete by hand.
Use to complete electronically. Please note that this form is not yet “clickable,” but you can overwrite the “checkboxes” with an X. We will try to make this clickable in the future.
Quarterly Needlestick and Sharp Object Injury Report (Revision Date: 01/01/2010)
Use for printing to complete by hand.
Use to complete electronically.
Annual Needlestick and Sharp Object Injury Report (Revision Date: 01/01/2010)
Use for printing to complete by hand.
Use to complete electronically.
Needlestick Reporting Contact Information Form (Revision Date: 01/01/2010)
Use for printing to complete by hand.
Use to complete electronically.