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Bio-Hazard Incident
Todays Date
First name
Last name
Incident Details
Date of Incident
Time of Incident
Location
Type of Biohazard
*
Required
Blood
Vomit
Feces
Chemical
Other
Are you the employee involved in dealing with the biohazard?
*
Yes
No
If no, who is employee that dealt with biohazard?
Were there any injuries?
*
Yes
No
If yes, Please Explain
Any special equipment used?
*
Yes
No
If yes, please specify
Is the client aware of the incident?
*
Yes
No
Time required to resolve incident?
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