Download the OSHA manual - Wisconsin Dental Association

NEEDLESTICK SAFETY AND PREVENTION ACT FORMListed below are the employees involved in selecting, disseminatingand collecting data relative to the following new safety devices.EMPLOYEE NAMEJane DoeJohn SmithPOSITION/TITLEDental HygienistDental AssistantFORMDescribe the process whereby input is requested:Annual meetings in which employees discuss alternative safety deviceswith the employer.Meeting date(s): ___________ 4/2006 ___________ 4/2007 ___________ 4/2008 ___________ ___________Minutes of Meeting(s)xAttached to this form Other:(Please Specify)Copies of documents used to request employee participationx Attached to this form Other:(Please Specify)Records of responses received from employees to the employer(s)(Such as reports evaluating effectiveness of a safer device)x Attached to this form Other:(Please Specify)2sSAMPLEOSHA EXPOSURE CONTROL PLAN…a member benefit from the WDA 10