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Sharps Injury Log

Featured OSHA Tools

Complete this form when an accident occurs that involves an occupational exposure to a potentially infectious substance via needlestick or other sharps injury. When you are finished, a printable report will be created. Click here for a printable version.

Remember to bookmark this page for future incidents!

1. Date/Time of Injury:

2. Injured Employee:

3. Employee Title:

4. Sharps Injury:
Did the device in use have engineered sharps injury protection?

5. Type/brand name of device involved in the exposure:

6. Was the device used properly?

7. Was the protective mechanism activated?

8. Did the exposure occur:

9. When did the exposure incident occur?

10. During other activity:

11. Location in facility where exposure occurred:

12. Procedure being performed at the time of the incident:

13. Body part involved in the injury:

14. Circumstances of the exposure:

15. Engineering controls/work practices/protective equipment/safety devices in use at the time of the incident:

16. Employee sent for evaluation and follow-up to : on

17. What will be done to prevent this type of injury from recurring?

18. Date Corrective Action Taken:

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