COVID-19 Products

COVID-19 Incident Report for Staff Exposure

Issue link: https://resources.rldatix.com/i/1223400

Contents of this Issue

Navigation

Page 1 of 15

COVID-19 Incident Report for Staff Exposure RLDatix Page 2 of 16 March 20, 2020 Revision 1 CONTENTS Introduction............................................................................................................................................................ 4 Form Preview ......................................................................................................................................................... 4 Employee Information ........................................................................................................................................... 9 Last Name:........................................................................................................................................................... 9 First Name: .......................................................................................................................................................... 9 Employee #: ......................................................................................................................................................... 9 Age: ...................................................................................................................................................................... 9 Sex: ...................................................................................................................................................................... 9 Address: ............................................................................................................................................................... 9 Contact details: .................................................................................................................................................... 9 Was employee N95 fit tested? ............................................................................................................................. 9 Was employee trained and fitted for Powered Air-Purifying Respirators (PAPR)? ............................................. 9 Was employee using appropriate fit tested mask at the time of the event? ........................................................ 9 Type of health care personnel: ............................................................................................................................ 9 Health care facility unit type where employee works? ....................................................................................... 10 COVID-19 Details ................................................................................................................................................. 10 Date of employee exposure to confirmed .......................................................................................................... 10 Was patient previously in another healthcare facility? ...................................................................................... 10 If yes, name of facility: ....................................................................................................................................... 10 Where multiple COVID-19 patients in health care facility at time of exposure incident? .................................. 10 Number of patients (approximate if exact number not known): ......................................................................... 10 Employee interactions/activities performed on or near COVID-19 patient ................................................... 11 Does the employee provide history of living in the same household environment with a confirmed COVID-19 patient? .............................................................................................................................................................. 11 Does the employee have history of traveling in proximity (within 1 meter) with a confirmed COVID-19 patient in any kind of conveyance? ............................................................................................................................... 11 Did employee provide direct care to a confirmed COVID-19 patient? .............................................................. 11 Was the employee in face-to-face contact (within 1 meter) with a confirmed COVID-19 patient in the health care facility? ....................................................................................................................................................... 11 Was the employee present when any aerosol generating procedures (AGP) was performed? ....................... 11 If yes, what type of AGP procedure? ................................................................................................................. 11 Did the employee have direct contact with the environment where the confirmed COVID-19 patient was cared for? E.g. bed, linen, medical equipment, bathroom, personal effects etc. ....................................................... 12 Was the employee involved with health care interaction(s); (paid or unpaid), in another health care facility during the period above? ................................................................................................................................... 12 Adherence to Infection Prevention Control (IPC) practices during health care interactions ..................... 12

Articles in this issue

view archives of COVID-19 Products - COVID-19 Incident Report for Staff Exposure