Health Care Safety Bloodborne Pathogen Home Data
Contaminated Sharps Injury Reporting
There are two versions of the reporting form. (1) A one page form (MS word, 92KB) with drop down lists that allows the form to be saved and use computerized data entry or (2) A three page form (PDF, 90KB) for manual completion.
Submit either the one-page MS Word form or the three-page PDF form from above. 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 at Regional. 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
Emerging and Acute Infectious Disease Branch
PO Box 149347 (Mailcode 1960), Austin, Texas 78714-9347
Fax number: 512-776-7616
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: Kelly Broussard@dshs.state.tx.us