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> a <br /> APPENDIX D: Post-Exposure Evaluation & Follow-Up Checklist <br /> -o a LineSa <br /> Post-Exposure Evaluation Follow-Up Checklist <br /> The following steps must be taken, and information transmitted, in case of an individual's <br /> exposure to Bloodbome Pathogens: <br /> Fill in the appropriate completion date for each action in the blank following the description: <br /> Description Date Completed <br /> 1) Employee fumished with documentation regarding exposure incident. <br /> 2) Source individual identified (Name .) <br /> 3) Source Individual's blood tested and results given to exposed individual. <br /> 4) Consent could not be obtained (Name .) <br /> 5) Exposed person's blood collected and tested. <br /> 6) Appointment made for exposed person to see health care professional. <br /> 7) Name of Health Care Professional <br /> 8) Documentation forwarded to Health-care Professional: <br /> ■ Bloodborne Pathogen Standard <br /> ■ Description of Exposed Person's Duties <br /> ■ Description of Exposure Incident, Including route(s) of Exposure <br /> ■ Result of Source Individual's Blood Testing <br /> ■ Exposed Person's Medical Records <br /> 14 <br />