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Attachment 1 <br /> INFORMATION TO THE MEDICAL PROVIDER FOLLOWING THE REPORT OF A BBP EXPOSURE <br /> (To be completed by the employee's supervisor or manager or the project manager and sent with the employee to the <br /> medical evaluation) <br /> Job Duties as They Relate To The Exposure Incident: The Employee is a designated first aid responder. <br /> Route of Exposure: <br /> (e.g., absorption through the skin, splashed in eyes, mouth or nose, etc.) <br /> Circumstances Under Which Exposure Occurred: <br /> (explain why the employee thinks he/she was exposed/came in contact with another person's blood or other bodily <br /> fluids) <br /> Results of Source Individual's/Victim's Blood Test: <br /> (if unavailable, if the blood hasn't been tested, if the source refused testing or the source is not known, note this) <br /> The employee's medical records, including Hepatitis B vaccination status, should be sent with the employee <br /> if not already available to the medical provider. <br /> A copy of the OSHA Bloodborne Pathogen Regulation will also be submitted to the medical provider if not <br /> already available to the provider. <br /> Revised 7/9/2021 <br />