Bloodborne Pathogens:

Model Exposure Control Plan for Wisconsin Schools

April 2009

All Wisconsin school districts are expected to develop and implement an exposure control plan to prevent and minimize employee exposure to blood borne pathogens. This document is a model of such a plan. It includes all of the required elements of an exposure control plan, but it is only a template in a suggested format. The plan can be modified to fit the district's needs. The only specific forms that should not be modified are the OSHA 300 log and the Worker's Compensation form, Medical Management of Individuals Exposed to Blood/Body Fluids. However, the content of the remaining samples must be included on whatever forms a district designs.

There are two versions of the document - one is interactive, which allows you to insert specific information into the document using the information prompts (highlighted in yellow) located throughout various sections of the document. By doing so, the document becomes an individualized plan for the school district. The other version is print-only.

Interactive version
Bloodborne Pathogens Exposure Control Plan
Exposure Control Definitions
Job Classification Exposure Determination Form
Tasks and Procedure Record
Example of a Written Procedure
Hepatitis B Vaccination Record Form
Hepatitis B Vaccine Declination Form
School Exposure Incident Investigation Form
Worker's Compensation Form SBD-10781
Needle-Stick/Sharps Injury Log
Information and Training of Employees
Employee Medical Records Checklist
Annual Review of Exposure Control Plan
Resources

Print-only version

More Information on School Nursing and Health Services

Other Student Services, Health, and Safety Resources

For questions about this information, contact Rachel Gallagher (608) 266-8857

Last updated on 2/23/2010 8:21:13 AM