Surveillance for Healthcare Personnel Exposure

• Exposure Module Training pdf icon[PDF – 1M]

• Healthcare Personnel Safety Component: Healthcare Personnel Exposure Module Protocol January 2013 pdf icon[PDF – 433K]

  Guidelines and procedures monitored in the Healthcare Personnel Safety Component or download the chapters individually:

  • Introduction to Healthcare Personnel Safety Component January 2013 pdf icon[PDF – 26K]
  • Monthly Reporting Plan January 2013 pdf icon[PDF – 22K]
  • Blood Body Fluid Exposure Options January 2013 pdf icon[PDF – 80K]  
  • Influenza Vaccination Exposure Managment Option January 2013 pdf icon[PDF – 49K]  
  • Tables of Instructions (for completing data collection forms) January 2013 pdf icon[PDF – 184K]
  • Key Terms January 2013 pdf icon[PDF – 61K]  
  • CDC Codes January 2013 pdf icon[PDF – 137K]

All Data Collection Forms are Print-only

• Tables of Instructions (for completing data collection forms) January 2013 pdf icon[PDF – 184K]
• 57.203 Healthcare Personnel Safety Monthly Reporting Plan Form January 2020 pdf icon[PDF – 80 KB]
  • Customizable form word icon[DOCX – 50 KB]
• 57.204 Healthcare Worker Demographic Data January 2020 pdf icon[PDF – 80 KB]
  • Customizable form word icon[DOCX – 50 KB]
• 57.205 Exposure to Blood/Body Fluids January 2020 pdf icon[PDF – 150 KB]
  • Customizable form word icon[DOCX – 80 KB]
• 57.206 Healthcare Worker Prophylaxis/Treatment BBF Postexposure Prophylaxis (PEP) January 2020 pdf icon[PDF – 80 KB]
  • Customizable form word icon[DOCX – 80 KB]
• 57.207 Follow-up Laboratory Testing form January 2020 pdf icon[PDF – 80 KB]
  • Customizable form word icon[DOCX – 50 KB]
• 57.210 Healthcare Worker Prophylaxis/Treatment Influenza form January 2020 pdf icon[PDF – 120 KB]
  • Customizable form word icon[DOCX – 50 KB]
• 57.200 Healthcare Personnel Safety Component—Annual Facility Survey form January 2020 pdf icon[PDF – 80 KB]
  • Customizable form word icon[DOCX – 50 KB]

• Key Terms January 2013 pdf icon[PDF – 61K]
• CDC Codes January 2013 pdf icon[PDF – 137K]
• Sharps Safety for Healthcare Settings
  Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program
• Centers for Disease Control and Prevention. Prevention and control of seasonal influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR 58, no. Early Release (2009):1-52.
• Methods and strategies used to collect healthcare personnel influenza vaccination data December 2013 pdf icon[PDF – 188K]
• Healthcare Personnel Safety Component – Variable Reference List pdf icon[PDF – 97K]
• Changing a CCN within NHSN (updated July 2015) pdf icon[PDF – 290K]