Weber State University

Weber State University

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Weber State University

Bloodborne Pathogens Exposure

Note to Clinical Instructor or Supervisor: Print this form, and ensure a completed copy is delivered to Human Resources (HR) Dept 1016 within 24 hours of the incident. If you have questions, contact HR at hr@weber.edu or by phone: 801-626-6184


Workers Compensation Insurance Information: Blood exposure to a WSU employee or student intern is covered under the university’s policy. If you or the health care agency have any questions, contact WSU’s coordinator at Phone: 801-626-6184.


Please note: For "Location" below, type a name or address to search buildings and outdoor areas on campus. If off campus, select "Off Campus" for "Campus, Building, or Outdoor Area."

Reporter Info

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Location

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    Exact Location

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    Exposed Individual's Information

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    Exposure Information

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    Medical Treatment

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    Signature Section

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    Add Supporting Documents

    Add files to upload as supporting documentation along with your incident report.