COVID-19 Products

COVID-19 Incident Report for Staff Exposure

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

Contents of this Issue

Navigation

Page 9 of 15

COVID-19 Incident Report for Staff Exposure RLDatix Page 10 of 16 March 20, 2020 Revision 1 ☐Volunteer ☐Other (specify): Health care facility unit type where employee works? ☐Outpatient ☐Emergency ☐Medical unit ☐Intensive care unit ☐Facility / Cleaning services ☐Laboratory ☐Pharmacy ☐Food Services ☐Infrastructure ☐Other, specify: COVID-19 Details Date of employee exposure to confirmed DD/MM/YYYY: __/__/____ • Not Known Was patient previously in another healthcare facility? • Yes • No • Unknown If yes, name of facility: Type of facility: ☐Hospital ☐Outpatient clinic ☐Primary health center ☐Rehabilitation care center ☐Long Term care center ☐Palliative care center ☐Home care for mild cases ☐Other, specify: Where multiple COVID-19 patients in health care facility at time of exposure incident? • Yes • No • Unknown Number of patients (approximate if exact number not known):

Articles in this issue

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