Download the OSHA manual - Wisconsin Dental Association

NEEDLESTICK SAFETY AND PREVENTION ACT FORMFor use in this dental office/practice/facilityListed below are the employees involved in selecting, disseminating,and collecting data relative to the following new safety devices.EMPLOYEE NAMEPOSITION/TITLEFORMDescribe the process whereby input is requested:2Meeting date(s): ___________ ___________ ___________ ___________ ___________Minutes of Meeting(s) Attached to this form Other:(Please Specify)Copies of documents used to request employee participation 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) Attached to this form Other:(Please Specify)FORUSE INOFFICEFORUSE INOFFICEReminder: Don’t forget to attach the actual documents that have been indicated on the checkboxes.OSHA EXPOSURE CONTROL PLAN…a member benefit from the WDA 11