Contaminated Sharps Injury Reporting

The Contaminated Sharps Injury Reporting form has been revised. There are now two versions of the form (1) A one page form ( MS word,79KB) with drop down lists that allows the form to be saved and use computerized data entry or (2) A four page form ( MS word, 164KB) for manual completion.

Submit either either the one-page (79Kb) MS Word form or the four-page (164Kb) MS Word form. DO NOT SEND BOTH FORMS

The facility where the injury occurred should complete the form and submit it to the local health authority where the facility is located. If no local health authority is appointed for this jurisdiction, submit to the regional director of the Texas Department of State Health Services regional office in which the facility is located. Address information for regional directors can be obtained on the Internet. The local health authority, acting as an agent for the Texas Department of State Health Services will receive and review the report for completeness, and submit the report to:

Texas Department of State Health Services Infectious Disease Surveillance and Epidemiology Branch
Mailcode 1960 PO Box 149347, Austin, Texas 78756-3199
Fax number: 512-458-7616

Copies of the Contaminated Sharps Injury Reporting Form can be also obtained from the Texas Department of State Health Services Public Health Regional Offices.

Please send comments and suggestions to: Kathryn.Gardner@DSHS.state.tx.us

Word document files require an application to read documents formatted in Microsoft word processing software. If you need to obtain a viewer for reading and printing such files, it is available for download it is available for download via additional file viewing information.