Surveillance for Healthcare Personnel Exposure

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

• Healthcare Personnel Vaccination Module: Influenza Vaccination Summary Protocol November 2017 pdf icon[PDF – 350K]
  Guidelines and procedures monitored in the Vaccination Module of the Healthcare Personnel Safety Component or download the chapters individually:
  • Introduction to Healthcare Personnel Safety Componentpdf icon
  • Monthly Reporting Planpdf icon
  • Influenza Vaccination Summarypdf icon
  • Key Termspdf icon
  • Appendix A – Influenza Vaccination Summary: List of Contracted Healthcare Personnelpdf icon

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]

• LTCF – Key Terms and Acronyms pdf icon[PDF – 209K]
• 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]