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EXPOSURE DETERMINATION FORMFor use in this dental office/practice/facilityDental Office/Practice/Facility Name:Address:Employer Name(s):must acknowledge their responsibility to provide all employees who perform taskswhich could potentially place them at risk for occupational exposure to bloodand/or other potentially infectious materials with full protection as stated in theOSHA Bloodborne Pathogens Standard 29 CFR part 1910.1030.This exposure determination has been made without regard to the use of personal protective equipment.FORM1List all job classifications in which employees haveoccupational exposure in this office/practice/facilityFORUSE INOFFICEList job classifications in which some, not all, employees,have occupational exposure in this office/practice/facilityJOB CLASSIFICATIONTASKS AND PROCEDURES IN WHICH OCCUPATIONAL EXPOSURE WILL OCCUROSHA EXPOSURE CONTROL PLAN…a member benefit from the WDA 6
METHODS OF IMPLEMENTATION AND CONTROLUNIVERSAL PRECAUTIONSOSHA Definition…“Universal Precautions” is an approach to infection control…all human blood and certain human bodyfluids are treated as if known to be infectious for HIV, HBV, HCV and other bloodborne pathogens.In this Dental Office/Practice/Facility, since medical history and examination cannot reliablyidentify all patients with Hepatitis B, C, HIV infection and/or other bloodborne pathogens, bloodand body fluid precautions are consistently used for all patients and when handling contaminatedinstruments, equipment, appliances, waste (regulated and other) and laundry.EXPOSURE CONTROL PLANEMPLOYEE RIGHTSIn this Dental Office/Practice/Facility: Employees covered by the Bloodborne Pathogens Standard receive an explanation of this ExposureControl Plan during their initial training session.This Exposure Control Plan is reviewed in employee’s annual training. Employees have an opportunity to review this plan at any time during their work shifts by contacting(Name of assigned staff person) If requested, I/we, the employer, will provide an employee with a written copy of this Exposure ControlPlan free of charge and within 15 days of the request.EMPLOYER RESPONSIBILITIESDirections: The spaces below are to be completed by either the employeror assigned staff person.EMPLOYER PAGEATTENTION ________________________ will review and update the Exposure Control Plan on annualbasis. Annual update of documentation will also include anassessment of technology changes that can reduce exposures. ________________________ will review and update the Exposure Control Plan more frequently,if necessary, to reflect any new or modified tasks and procedures. ________________________ will review and update the Exposure Control Plan to reflect new orrevised employee positions with occupational exposure.OSHA EXPOSURE CONTROL PLAN…a member benefit from the WDA 7
Page 4 and 5: TABLE OF CONTENTSHEPATITIS B VACCIN
Page 6 and 7: EXPOSURE CONTROL PLAN, PURPOSE AND
Page 8 and 9: EXPOSURE DETERMINATIONDEFINITIONOSH
Page 12 and 13: ENGINEERING AND WORK PRACTICE CONTR
Page 14 and 15: NEEDLESTICK SAFETY AND PREVENTION A
Page 20 and 21: PERSONAL PROTECTIVE EQUIPMENTThe pe
Page 22 and 23: PERSONAL PROTECTIVE EQUIPMENT CONTI
Page 24 and 25: HOUSEKEEPING CONTINUEDC. IN-HOUSE L
Page 26 and 27: HEPATITIS B VACCINATION AND ANTIBOD
Page 28 and 29: HEPATITIS B VACCINATION DECLINATION
Page 30 and 31: POST-EXPOSURE EVALUATION AND FOLLOW
Page 32 and 33: OCCUPATIONAL EXPOSURE INCIDENT REPO
Page 34 and 35: INFORMATION AND TRAININGIn this Den
Page 36 and 37: OSHA BLOODBORNE PATHOGENS STANDARD
Page 38 and 39: RECORD KEEPINGIn this Dental Office
Page 40 and 41: APPENDIXEMPLOYER REFERENCE PAGESOCC
Page 42 and 43: APPENDIXThe Hepatitis B vaccine doe
Page 44 and 45: APPENDIXEMPLOYER FREQUENTLY ASKED Q
Page 46 and 47: APPENDIXWEB SITES FOR REFERENCE DOC
Page 48 and 49: APPENDIXOSHA EXPOSURE CONTROL PLAN
Page 50 and 51: APPENDIXONLY FOR EMPLOYERS HIRING M
Page 52 and 53: OSHA EXPOSURE CONTROL PLAN…a memb

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