New Jersey Department of Health

PEOSH Unit

EMPLOYEE EDUCATION AND TRAINING RECORD

Name of Employee (Print)	Date of Hire
Job Title	Date Assigned
INITIAL TRAINING
SUBJECT	DATE	LOCATION	TRAINER	EMPLOYEE SIGNATURE
a.	The Standard
b.	Epidemiology and Symptoms of Bloodborne Diseases
c.	Modes of Transmission
d.	Exposure Control Plan
e.	Recognizing Potential Exposure
f.	Use and Limitations of Exposure Control Methods
g.	Personal Protective Equipment (PPE)
h.	Selection of PPE
i.	HBV Immunization Program
j.	Emergencies Involving Blood or Potentially Infectious Materials
k.	Exposure Follow-up Procedures
l.	Post Exposure Evaluation and Follow-up
m.	Signs and Labels
n.	Opportunity to Ask Questions
ADDITIONAL TRAINING
SUBJECT	DATE	LOCATION	TRAINER	EMPLOYEE SIGNATURE
ANNUAL RETRAINING
SUBJECT	DATE	LOCATION	TRAINER	EMPLOYEE SIGNATURE

OCC-9

JAN 13

OCC-

OCT 08	29 CFR 1910.1030, OSHA’s Bloodborne Pathogens Standard, in paragraph (h)(5), requires an employer to establish and maintain a Sharps Injury Log for recording all percutaneous injuries in a facility occurring from contaminated sharps. The purpose of the Log is to aid in the evaluation of devices being used in healthcare and other facilities and to identify problem devices or procedures requiring additional attention or review. This log must be kept in addition to the injury and illness log required by 29 CFR 1904. The Sharps Injury Log should include all sharps injuries occurring in a calendar year. The log must be retained for five years following the end of the year to which it relates. The Log must be kept in a manner that preserves the confidentiality of the affected employee.

OCC-9, Employee Education and Training Record

OCC-9, OCC, employee education and training record, PEOSH, occupational health

ewhite

2009-02-25

NJDOH