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Arizona Report of Significant Work Exposure to Bodily Fluids or Other Infectious Material

State:
Arizona
Control #:
AZ-WC-31
Format:
PDF
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Description

SIGNIFICANT EXPOSURE UNDER THE ARIZONA WORKERS' COMPENSATION ACT The Arizona Report of Significant Work Exposure to Bodily Fluids or Other Infectious Material is a form that is required to be completed by all healthcare providers when an employee has a significant work exposure to bodily fluids or other infectious material. This form must be completed and sent to the Arizona Department of Health Services within 24 hours of the exposure incident. The form must include the date and time of the exposure, the type of exposure, the body fluid or infectious material, and the protective clothing and equipment worn at the time of exposure. It must also include the employee’s name, the name and contact information of the supervisor, and the name and contact information of the employee’s healthcare provider. There are two types of Arizona Report of Significant Work Exposure to Bodily Fluids or Other Infectious Material: the Standard Report and the High Risk Report. The Standard Report is designed for exposures to body fluids that are unlikely to be infectious and does not require additional information or testing. The High Risk Report is designed for exposures that have a greater potential to transmit infection and requires additional information or testing.

The Arizona Report of Significant Work Exposure to Bodily Fluids or Other Infectious Material is a form that is required to be completed by all healthcare providers when an employee has a significant work exposure to bodily fluids or other infectious material. This form must be completed and sent to the Arizona Department of Health Services within 24 hours of the exposure incident. The form must include the date and time of the exposure, the type of exposure, the body fluid or infectious material, and the protective clothing and equipment worn at the time of exposure. It must also include the employee’s name, the name and contact information of the supervisor, and the name and contact information of the employee’s healthcare provider. There are two types of Arizona Report of Significant Work Exposure to Bodily Fluids or Other Infectious Material: the Standard Report and the High Risk Report. The Standard Report is designed for exposures to body fluids that are unlikely to be infectious and does not require additional information or testing. The High Risk Report is designed for exposures that have a greater potential to transmit infection and requires additional information or testing.

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Arizona Report of Significant Work Exposure to Bodily Fluids or Other Infectious Material