Los Padres National Forest
BLOODBORNE PATHOGENS
EXPOSURE CONTROL PLAN
2011
PREPARED BY:
Tony Martinez
TONY MARTINEZ
Forest Safety Officer
Date: 12/01/2010
REVIEWED BY:
James M. Lopez
JAMES M. LOPEZ
Union President
Date: 1/18/2011
APPROVED BY:
Peggy Hernandez
PEGGY HERNANDEZ
Forest Supervisor
Date: 9/7/2011
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PREFACE
The purpose of the Bloodborne Pathogen Standard, Bloodborne Pathogen Program, and this
Exposure Control Plan are explained in the first section however, a few points are worth making
to introduce the topic. The Bloodborne Pathogens (BBP) Program applies only to those
employees who have “occupational exposure” to potentially infectious materials. It is important
to understand the definition of terms as it relates to this standard. An occupational exposure is
defined as reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood
or other potentially infectious materials resulting from the performance of an employee's duties.
Employees, who perform "Good Samaritan" acts, shall not be included in the exposure
determination unless they provide assistance as a member of an emergency medical team or
are otherwise reasonably expected to render medical assistance as an official duty.
Employees, who receive first-aid instruction and certification for their own benefit (whether
funded at their own expense or by the Forest Service) and who are not expected to provide
first-aid in an official capacity, would not be enrolled in the program.
However, the BBP Program does apply to all employees in the event of an exposure incident as
relates to post exposure protocols. An exposure incident is defined as a specific eye, mouth,
other mucous membrane, non-intact skin, or parenteral (parenteral means piercing mucous
membranes or the skin barrier through such events as needlesticks, human bites, cuts, and
abrasions) contact with blood or other potentially infectious materials (body fluids) resulting
from performance of an employee's duties.
Potentially infectious materials include blood and body fluids containing visible blood. The
following fluids also are considered potentially infectious semen and vaginal secretions,
cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid, and amniotic
fluid. The risk for transmission of Hepatitis Viruses (HBV, HCV), and Human
Immunodeficiency Virus (HIV or AIDS) infection from these fluids is unknown. Feces, nasal
secretions, saliva, sputum, sweat, tears, urine, and vomitus are not considered potentially
infectious, unless they contain blood. The risk for transmission of HBV, HCV, and HIV infection
from these fluids and materials is extremely low.
Exposure Incidents are treated as employee injuries/illnesses. The program includes a post
exposure protocol and timeframes, which must be followed. Reporting, as required for other
injuries and illnesses in the SHIPS system, also applies.
Employees determined to have an occupational exposure will be offered a Hepatitis B
vaccination series. The post exposure protocol for employees, who act in the capacity of a good
samaritan, will be offered the Hepatitis B vaccination as part of post exposure prophylaxis as
recommended by the health care professional. Vaccinations may serve as preventive measures,
but may also involve risk factors of which employees must be aware.
Questions about the BBP Program should be directed to the Forest Safety Officer.
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TABLE OF CONTENTS
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Authority
02
Objective
03
Policy
04
Responsibility
05
Bloodborne Pathogen, Exposure Control Plan
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Method of Compliance
Universal Precautions
Engineering and Work Practice Controls
Engineering Controls
Work Practice Controls
First Aid/CPR
Handling/Disposal Hypodermic Needles/Syringes
Handling used Band-Aids, Napkins, and Condoms
Guidelines for Hand Washing
Food, Drink and Personal Items
Personal Protective Equipment (PPE)
Housekeeping
General
Regulated waste; Contaminated Sharps
Laundry
Hepatitis B Vaccination (HBV) & Post-Exposure Evaluation
General
HBV
Post-exposure Evaluation and Follow-up
Information to Health Care Professionals
Health Care Professionals Written Opinion
Communication of Hazards to Employees
Labels and Signs
Information and Training
Medical Recordkeeping
Availability
Transfer of Records
Safety and Health Information Portal System (SHIPS)
Effective Dates
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Attach 1, FS-6700-11, BBP Exposure Control Plan Schedule and Method of Implementation
Attach 2, FS-6700-9, BBP Exposure Determination – All Employees Exposed
Attach 3, FS-6700-10, BBP Exposure Determination – Some Employees Exposed
Attach 4, FS-6700-13, BBP Housekeeping Schedule and Methods of Decontamination
Attach 5, Hepatitis B Vaccination Record and Consent Form
Attach 6, FS-6700-14, Hepatitis B Vaccine Declination Statement (Mandatory)
Attach 7, 8, 9 FS-6700-12ABC, BBP Exposure Incident Report, Part 1, 2, 3
Attach 10, FS-6700-15, BBP Post Exposure Evaluation and Follow-up Report
Attach 11 & 12, FS-6700-16, BBP Training Record Parts A & B
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01. AUTHORITY:
Occupational Safety and Health Act of 1970
Executive Order 12196; Occupational Safety and Health programs for Federal Employees
Title 29, Code of Federal Regulations (CFR), part 29 CFR 1960; U.S. Department of Labor,
Occupational Safety and Health Administration (OSHA) Elements for Federal Employee
Occupational Safety and Health Programs
Title 29, Code of Federal Regulations (CFR), part 29 CFR 1910; U.S. Department of Labor,
Occupational Safety and Health Administration (OSHA) Regulations for General Industry
Title 29, Code of Federal Regulations (CFR), part 29 CFR 1926; U.S. Department of Labor,
Occupational Safety and Health Administration (OSHA) Regulations for the Construction
Industry
Forest Service Manual (FSM) 6700; USDA Forest Service, Safety and Health Program
Forest Service Handbook (FSH) 6709.11; USDA Forest Service, Health and Safety Code
Forest Service Handbook (FSH) 6709.12; USDA Forest Service, Safety and Health Program
02. OBJECTIVE:
The Forest Service Bloodborne Pathogens (BBP) Program is designed to protect Forest Service
employees from occupational exposure to Hepatitis B Virus (HBV), Human Immunodeficiency
Virus (HIV), and other bloodborne pathogens. This program can minimize or eliminate
occupational exposure through a combination of engineering and work practice controls:
personal protective clothing, personal protective equipment, employee training, medical
surveillance, Hepatitis B vaccinations, labeling, and other provisions as defined by this section.
All Forest Service employees with occupational exposures to blood or other potentially
infectious materials shall be enrolled in the Forest Service Bloodborne Pathogens Program,
including training and vaccinations.
All Forest Service employees, especially those with occupational exposure, shall observe
universal precautions at all times when blood or other potentially infectious materials are known
or suspected to be present.
The Bloodborne Pathogens/Exposure Control Plan will be reviewed and updated at least
annually and whenever necessary to reflect new or modified tasks and procedures, which affect
occupational exposures, and to reflect new or revised employee position descriptions with
occupational exposure.
It should be noted the Post Exposure Evaluations and Follow-up may apply to employees beyond
those formally enrolled in the program following an Exposure Incident. All exposures to blood
or other potentially infectious materials incidents should be treated as employee’s injuries to
ensure appropriate follow-up, as described in the Bloodborne Pathogens Program.
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03. POLICY:
It is the policy of this Forest to provide a comprehensive BBP Program, which offers maximum
protection against BBP for all employees.
Apply the Forest BBP Program to all personnel (career, seasonal, temporary, and volunteers),
who will provide services to employees whose work activities could expose them to bloodborne
pathogens.
Provide all employees with the necessary training, personal protective equipment (PPE) and
immunizations needed to ensure protection from Bloodborne Pathogens.
Prohibit the discrimination of any employee or visitor for health reasons.
Regard all medical records and information as strictly confidential. No employee’s health
information will be released without the consent of the employee.
04. RESPONSIBILITY:
It is the responsibility of the Forest Supervisor, District Rangers and Staff Officers to ensure full
and effective implementation of this program at all respective unit levels. Work supervisors
shall determine which employees are occupationally exposed and ensure they comply with the
requirements outlined in this program. It is also the responsibility of work supervisors to
maintain training documentation on this program and convey training rosters and medical
documentation, such as vaccination or declination forms and post exposure reports as identified
in the program to the Forest Safety Officer. The Forest Safety Officer will then arrange for
record retention at the Albuquerque Service Center Human Resource Management Office (ASCHRM).
Forest employees with an occupational exposure shall comply with the requirements of this plan.
Any employee, who declines to accept the Hepatitis B Vaccine and vaccination offered through
the Forest Service Bloodborne Pathogens Program, shall sign the Hepatitis B Vaccine
Declination Statement. (Mandatory – see Attachment 3)
Supervisors shall ensure employee compliance with Forest Service Bloodborne Pathogens
Program for occupationally exposed employees at their appropriate organizational level. In the
event of a bloodborne pathogen exposure incident when PPE is not used, it is the responsibility
of the supervisor to report these incidents to the District Ranger, Forest Safety Officer, and the
Forest Supervisor.
All employees shall observe precautions at all times to prevent contact with blood or other
potentially infectious materials. Unidentifiable body fluids that are encountered shall be
considered potentially infectious materials. Occupational exposure can be eliminated or
minimized through engineering and work practice controls (including substitution, administrative
controls, and use of personal protective clothing and equipment).
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The Forest Safety Officer, in consultation with members of each Safety Committee will annually
review and update the BBP Program to reflect new or modified programs of work, which affect
occupational exposures or new regulations or policies related to BBP.
The Forest Safety Officer will ensure a copy of this plan is made available to all employees.
05. BLOODBORNE PATHOGEN EXPOSURE CONTROL PLAN:
This Exposure Control Plan is written and designed to eliminate or minimize employee exposure
to Bloodborne Pathogens in the workplace. This Exposure Control Plan does cover the elements
listed below, as well as elements listed in the Exposure Control Plan Schedule and on the Forest
Implementation Form (FS- 6700-11, attachment 1):
Exposure Determination and methods of compliance including, housekeeping, Hepatitis B
Vaccinations (HBV) and post-exposure evaluations and follow-up, communication of hazards to
employees, recordkeeping and effective dates.
Exposure Determination
This exposure determination is based on the definition of occupational exposure without regard
to personal protective equipment and clothing (Form FS-6700-9, attachment 2). The exposure
determination is made by reviewing job classifications within the work environment, and listing
exposures into two groups. It is the responsibility of management to determine which job
classifications have occupational exposure to blood or other potentially infectious materials. The
first group includes job classifications in which all of the employees have occupational exposure.
Where all employees have occupational exposure, it is not necessary to list specific work tasks.
The second group includes those classifications in which some of the employees have
occupational exposure (Form FS-6700-10, attachment 3). Where only some employees have
occupational exposure, specific tasks and procedures causing occupational exposure must be
listed. This standard covers Los Padres National Forest employees, who are full time, part time,
permanent, and temporary.
Identification of Employees at Risk
The exposure determination is made by reviewing job classifications within the work
environment and listing those with exposure potential. Those job classifications in which all of
the employees may have occupational exposure are:
Law Enforcement Officers (LEO) and Law Enforcement Investigators (LEI)
Emergency Medical Services (EMS);
Emergency Medical Technician (EMT)
Medical First Responders
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Those job classifications in which some of these employees may have occupational exposure
are:
Engineering Maintenance Personnel (e.g. waste water systems repair and testing)
Warehouse Personnel (e.g. fire cache or receive wildland fire equipment)
Recreation Technicians and Volunteers (e.g. gather and dispose of refuse at camp grounds)
Employees with assigned first aid responsibilities (assignment letter must be
maintained on file, with a copy forwarded to Forest Safety Officer)
Employees identified in these job classifications will be enrolled in the Bloodborne Pathogens
Exposure Control Program. Hepatitis B Virus (HBV) vaccine will be offered to these employees
as a matter of prevention and at no cost to the employee.
Employees who perform "Good Samaritan" acts shall not be included in the exposure
determination, unless they provide assistance as a member of an emergency medical team or are
otherwise reasonably expected to render medical assistance as an official duty. Employees, who
receive first-aid instruction and certification for their own benefit (whether funded at their own
expense or by the Forest Service) and who are not expected to provide first-aid in an official
capacity, would not be enrolled in the program.
06. METHOD OF COMPLIANCE:
Universal Precautions is the practice of treating all body fluids as if they are infectious for HBV,
HIV and other bloodborne pathogens. As it is difficult or impossible to differentiate between
body fluid types, all body fluids should be assumed to be potentially infectious. All medical
responses should be conducted as if the patient is infectious. Many patients do not know if they
are infected with bloodborne pathogens. In the words of Gordon Graham, “If it’s wet, if it’s not
yours, don’t touch it!”
Annual review of this BBP and Exposure Control Plan may identify new and/or improved
engineering controls, which will be updated or replaced in this plan as needed. Hand washing
facilities will be made readily accessible to all employees, who have the potential for exposure.
Where soap and water are not available, antiseptic hand cleaners and clean towels, or antiseptic
towels will be made available. If contamination occurs away from a hand washing facility,
employee will use antiseptic hand cleaners and clean towels, or antiseptic towels to clean
contaminated area.
When antiseptic hand cleansers or towelettes are used, employee will wash hands and/or
contaminated parts of their body with running water, as soon as possible.
Supervisors and work leaders will ensure employees wash their hands and any other exposed
skin (immediately after removal of gloves or other PPE) with soap and water, flush mucous
membranes with water immediately or as soon as feasible, following contact with blood or other
potentially infectious materials.
Containers used for storage, shipping, and transport of contaminated materials will be puncture
resistant, color coded or labeled with biohazard warning label, and will be leak proof.
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Work Practice Controls are the safe work practices reducing employee exposure by either
removing the hazard or isolating the worker from exposure when involved in activities with
potential for exposures. Hand washing facilities will be made readily accessible to all employees,
who have the potential for exposure. Where soap and water are not available, antiseptic hand
cleaners and clean towels, or antiseptic towels will be made available. If contamination occurs
away from a hand washing facility, employee will use antiseptic hand cleaners and clean towels,
or antiseptic towels to clean contaminated area.
When antiseptic hand cleansers or towelettes are used, employee will wash hands and/or
contaminated parts of their body with running water, as soon as possible.
Supervisors and work leaders will ensure employees wash their hands and any other exposed
skin (immediately after removal of gloves or other PPE) with soap and water, flush mucous
membranes with water immediately, or as soon as feasible following contact with blood or other
potentially infectious materials.
Work Practice Controls also include the Safe Work Practices as they relate to specific tasks
accociated with BBP and infection control.
First Aid/CPR
Employees should wear personal protective equipment (PPE) before beginning First Aid/CPR,
use disposable resuscitation equipment and devices once, and dispose of them. Reusable
equipment must be thoroughly cleaned and disinfected after each use according to manufacturer's
recommendations and vinyl, nitrile or latex gloves should be worn when administering First
Aid/CPR.
Handling/Disposing of Hypodermic Needles/Syringes
Avoid picking up by hand any hypodermic needles/syringes and always use a litter grabber,
needle/ syringe keeper, pliers, or tongs to avoid direct contact. Pick up away from the point,
always wear gloves, as an added precaution, even when using a litter grabber, needle/syringe
keeper, pliers or tongs. Place needles/syringes directly into a hard plastic or metal SHARPS
container. Document time and place found, and dispose as medical waste. If SHARPS container
is not immediately available, use a labeled, puncture-resistant container to transport to a
SHARPS container. Disposal should be conducted through agreement with a local hospital,
clinic, or medical facility which knows the proper disposal procedure. Be aware that
needle/syringes may be found where you least expect them. NEVER USE HANDS OR FEET
TO CRUSH GARBAGE or hold garbage bags against your legs or torso for any reason. Do not
push on bags to get air out and eliminate contact with the body.
Handling used Band-aids, Sanitary Napkins, Tampons, or Condoms
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DO NOT PICK UP BY HAND. Always use a litter grabber or pickup stick. Always wear
gloves as an added precaution, even when using a litter grabber device. Devices that are used for
pickup of such items should be disinfected via chemical germicide or through a solution of
household bleach and water, (1:10 solution of bleach in water, or 12 ounces of bleach per gallon
of water). Bleach solutions must be made fresh each time they are used.
Guidelines for Hand Washing
Body substances, which may contain disease organisms, can easily contaminate your hands and
may be transmitted from hands to body openings, if personal hygiene is not practiced. Hand
washing is one of the most effective methods of disease control, since hand washing facilities
may not always be readily available, antiseptic towelettes or antiseptic cleanser should be
provided in the first-aid kits or supplies. When antiseptic hand cleansers and towels are used,
hands shall be washed with soap and water as soon as feasible. Employees shall wash their
hands and other affected skin promptly with soap and water after removal of gloves and other
personal protective clothing and equipment. Mucous membranes shall be flushed with water
immediately or as soon as feasible following contact with blood or other potentially infectious
materials.
Food, Drink and Personal Items
Eating, drinking, smoking, applying cosmetics, lip balm or lotions, or handling contact lenses is
prohibited in work areas where there is potential for exposure to bloodborne pathogens. Food
and drink are not to be kept in refrigerators, in freezers, on countertops, or in other areas where
blood or other potentially infectious materials are present.
NOTE: Refer also to Appendices E and F: Exposure Control Guides for the Scene Operations
and Post Response.
PERSONAL PROTECTIVE EQUIPMENT
Provision
The Forest Service shall provide, at no cost to employees; materials, equipment, personal
protective equipment (PPE), and protective clothing, to protect employees determined to have
occupational exposure to BBP. Clothing and equipment may include, but is not limited to,
gowns, aprons, laboratory coats/clinical jackets, or similar outer garments, gloves, face shields or
masks, and eye protection, mouthpieces, resuscitation bags, pocket masks, and other ventilation
appliances as may be identified. These types of equipment should be carried in vehicles and to
the field to support the activities of employees determined to have occupational exposures.
Use
Supervisors shall ensure employees are provided with and use appropriate personal protective
equipment and clothing based on the type and characteristics of the task and degree of exposure
anticipated.
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Accessibility
Appropriate personal protective clothing and equipment shall be readily accessible at the
worksite and/or issued directly to employees. It shall be cleaned, laundered, and disposed of, as
required (at no cost to the employee) and repaired and/or replaced, as needed to maintain their
effectiveness.
Cleaning, Laundering, and Disposing
Contaminated personal protective clothing and equipment shall be removed prior to leaving the
worksite and placed in an appropriately designated area or container for storage, washing,
decontamination, or disposal.
Repair and Replacement
Supervisors will ensure all personal protective equipment is either repaired or replaced when
equipment is unserviceable or cannot be utilized for its intended use. Any personal equipment
penetrated by blood or potentially infections materials will be taken out of service and replaced
immediately, or as soon as possible.
Gloves
Rubber gloves shall be made available to all employees and worn when hand contact with blood
or other potentially infectious materials is anticipated. Disposable (single use) gloves shall be
replaced when contaminated, or as soon as feasible when their ability to function as a barrier is
compromised (disposable gloves shall never be washed or decontaminated for re-use).
Mask, Eye Protection, and Face Shields
Masks in combination with eye protection, such as goggles or glasses with solid side shields or
chin length face shields, shall be worn whenever eye, nose, mouth, or airborne transmission can
be reasonably anticipated.
Gowns, Aprons, and Other Protective Body Clothing
Appropriate protective clothing such as, but not limited to, gowns, aprons, lab coats, or similar
outer garments shall be worn in occupational exposure situations. The type and characteristics
will depend upon the task and degree of exposure anticipated.
Personal protective equipment will be considered "appropriate" only if it does not permit blood
or other potentially infectious materials to pass through to or reach the employee's work clothes,
street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal
conditions of use and for the duration of time, which the protective equipment will be used.
NOTE: Refer also to Appendix D: Exposure Control Guide for Personal Protective Equipment.
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HOUSEKEEPING:
Supervisors will ensure the worksite is maintained in a clean and sanitary condition. Appropriate
BBP housekeeping practices, schedules, and methods of decontamination (FS-6700-13,
attachment 4) shall be identified by a job hazard analysis to prevent or minimize contact with
contaminated equipment and work surfaces. Supervisors will ensure all equipment and working
environments, including working surfaces, will be cleaned and decontaminated, after contact
with blood or other potentially infections materials.
Contaminated work surfaces shall be decontaminated with an appropriate disinfectant after
completion of procedures immediately or as soon as feasible when surfaces are overtly
contaminated, or after any spill of blood or other potentially infectious materials, and at the end
of work shift, if the surface may have become contaminated since the last cleaning.
All protective coverings, such as plastic wrap, aluminum foil, or imperviously-backed absorbent
paper used to cover equipment and environmental surfaces, will be removed and replaced as
soon as feasible when they become overtly contaminated or at the end of the workshift, if they
may have become contaminated during the shift.
All bins, pails, cans, and similar receptacles intended for reuse, which have a reasonable
likelihood for becoming contaminated with blood or other potentially infectious materials, will
be inspected and decontaminated on a regularly scheduled basis and cleaned and decontaminated
immediately or as soon as feasible, upon visible contamination.
Broken glassware, which may be contaminated, will not be picked up directly by hand. It will be
cleaned up using mechanical means, such as a brush and dust pan, tongs, or forceps.
Regulated Waste, Contaminated Sharps Discarding, and Containment
Contaminated sharps will be discarded immediately, or as soon as feasible, in containers that are
closable, puncture resistant, leak proof on sides and bottom, and labeled or color-coded in
accordance with this plan. During use, containers for contaminated sharps shall be easily
accessible to personnel, located as close as is feasible to the immediate area where sharps are
used, maintained upright throughout use, and replaced routinely and not be allowed to overfill.
When moving containers of contaminated sharps, the containers will be closed prior to removal
preventing spillage or protrusion of contents, placed in a secondary container (if leakage is
possible), constructed to contain all contents during handling, or storage. Regulated waste
containment will be placed in containers, which are closable, constructed to contain contents
preventing leakage during handling or storage, and labeled or color-coded in accordance with
this plan.
Supervisors will ensure contaminated sharps will be discarded immediately, or as soon as
feasible in approved SHARPS containers. At a minimum, contaminated SHARPS containers
will be disposed of when filled to the limit line or sooner.
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Supervisors will ensure that Bio-hazard waste, which may include dressings, contaminated
clothing, and other medical waste will be disposed of in bio-hazard waste bag. Bio-hazard bags
will be available on all emergency vehicles. NOTE: disposal of all regulated waste shall be in
accordance with all applicable Federal, State, and local laws and regulations. Universal
precautions shall be observed at all times, including in the handling of potentially infectious
waste. Appropriate work practices for regulated waste shall be identified by a job hazard
analysis. When possible, infectious wastes generated from cleaning and decontamination during
responses with other agencies should be properly packaged and disposed of with the cooperating
agency, ambulance or medical unit.
Laundry
Contaminated laundry shall be handled, as little as possible, with a minimum of agitation. It
shall be bagged or containerized at the location where it was used and will not be sorted or rinsed
in the location of use. Contaminated laundry will be placed and transported in bags or containers
labeled or color-coded in accordance with this plan. Whenever contaminated laundry is wet and
presents a reasonable likelihood of soak-through or leakage from the bag or container, the
laundry shall be placed and transported in bags or containers, which prevent soak-through and/or
leakage of fluids to the exterior. Supervisors will ensure that employees, who have contact with
contaminated laundry, wear protective gloves and other appropriate personal protective
equipment. Employees must remove personal protective clothing before leaving the work area
or when the clothing becomes contaminated. If a garment is penetrated, workers must remove it
immediately or as soon as feasible. Used protective clothing and equipment must be placed in a
designated area or in containers for storage, washing, decontamination, or disposal. Forest
Service emergency vehicles will carry a change of clothes for employees determined to have an
occupational exposure. Supervisors will ensure employees store uncontaminated clothing on
their respective module. Any damaged or unsalvageable personal clothing owned by the
employee and authorized for Forest Service use will be repaired or replaced at no cost to the
employee.
HEPATITIS B Vaccination, Post-Exposure Evaluation, and Follow-Up
Los Padres National Forest will make available the Hepatitis B vaccine and vaccination series to
all employees, who have occupational exposure, and post-exposure evaluation, and follow-up to
all employees, who have had a blood borne pathogen exposure incident.
Hepatitis B Vaccination (HBV)
The Hepatitis B Vaccination (HBV) will be made available only after the employee has received
the training required in this plan (within 10 working days of initial assignment). HBV is also
available to all employees, who have occupational exposure, unless the employee has previously
received the complete Hepatitis B vaccination series, and the antibody testing has revealed the
employee is immune, or the vaccine is contraindicated for medical reasons.
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All medical evaluations and procedures shall be available at no cost to the employee, available to
the employee at a reasonable time and place, performed according to recommendations of the
U.S. Public Health Service, and under the supervision of a licensed health care professional. All
laboratory testing shall be conducted by an accredited laboratory at no cost to the employee.
Employees will not be required to participate in a prescreening program as a prerequisite for
receiving the Hepatitis B vaccinations.
Prior to receiving the HBV, employees will complete the HBV Consent Form (attachment 5;
see last page this document).
Employees with occupational exposure, who decline to accept the HBV offered by the Forest
Service will sign the mandatory Statement of Declination Form (FS-6700-14, attachment 6).
Employees may not sign a statement of declination until they have received training in the BBP
Exposure Control Plan. In the event the employee refuses to sign the statement of declination
form, the supervisor will document on the form the employee refused to sign the statement of
declination. The supervisor will sign and date the statement.
If the employee initially declines the HBV, but at a later date, while still covered under this plan,
decides to accept the HBV, the employer will make available HBV at that time.
If routine booster dose of HBV is recommended by the U.S. Public Health Service at a future
date, such booster dose will be made available in accordance with this plan.
Supervisors will ensure all medical evaluations and procedures are afforded to each employee
including the HBV and vaccination series and post-exposure evaluation and follow-up, including
prophylaxis. The HBV is authorized for all employees determined to have an occupational
exposure.
HBV will not be made available to employees, who have HBV contraindication for medical
reasons, previously received the complete HBV series, or have sufficient immunity levels based
on antibody testing. Antibody testing can be conducted 4-12 weeks after the third vaccination in
the series to determine if the employee has an acceptable immunity level.
Post-exposure Evaluation and Follow-up
Employees are eligible for post exposure treatment, who receive a specific eye, mouth, other
mucous membrane, non-intact skin or parenteral contact with bloodborne pathogen, or other
potentially infectious materials resulting from the performance of their duties or who perform
“Good Samaritan” acts during official duty hours.
Following a report of an exposure incident (FS 6700-12A, B, & C, attachments 7, 8 & 9), the
supervisor, representing the Forest Service as the employer, shall make immediately available to
the exposed employee a confidential medical evaluation (FS- 6700-15, attachment 10) and
follow-up, including at least the following elements: documentation of the route(s) of exposure,
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and circumstances under which the exposure incident occurred, identification and documentation
of the source individual, unless the Forest can establish that identification is infeasible or
prohibited by State or local law. The source individual’s blood shall be tested as soon as feasible
and after consent is obtained in order to determine HBV/ HIV infectivity. If consent is not
obtained, the Forest shall establish that legally required consent cannot be obtained. When the
source individual’s consent is not required by law, the source individual’s blood, if available,
shall be tested and the results documented. When the source individual is already known to be
infected with HBV or HIV, testing for the source individual’s known HBV or HIV status is not
repeated. Results of the source individual’s testing shall be made available to the exposed
employee(s) and the employee(s) shall be informed of applicable laws and regulations
concerning disclosure of the identity and infectious status of the source individual.
Collection and testing of blood for HBV and HIV serological status
The exposed employee’s blood shall be collected, as soon as feasible, and tested after consent is
obtained. If the employee consents to baseline blood collection, but does not give consent at that
time for HIV serologic testing, the sample shall be preserved for at least 90-days. If, within 90days of the exposure incident, the employee elects to have the baseline sample tested, such
testing shall be done, as soon as feasible.
Within 24-hours of exposure or potential exposure to bloodborne pathogen or infectious
materials, begin the HBV Series. If exposed, while performing emergency first aid without
proper personal protective equipment, it is recommended exposed employee(s) be
transported to the closest medical provider or emergency care unit. This allows for
immediate evaluation in the event of an exposure and the beginning of emergency treatment, as
needed.
The Authorization for Treatment Form (CA-16) can be obtained by calling the Albuquerque
Service Center, (ASC), Office of Workers Compensation Programs (OWCP) to request
assistance. ASC operates Monday – Friday: 0700 – 1800 (Mountain Time) 1-877-372-7248,
option 2, option 5
Incident investigation should be initiated within 24-hours after the incident occurs and involves
gathering and documenting the incident information. Exposure incidents will be treated as
employee injuries/illnesses and entered into the Safety and Health Information Portal System
(SHIPS)
Note: Post Exposure Forms are included in the attachments to this Plan to facilitate and
document follow-up activities.
If an employee, who has been enrolled in the Bloodborne Pathogens Program becomes involved
in a separate and unrelated occupational exposure incident, the affected employee shall proceed
with evaluation, treatment, and documentation, as outlined in this Section. This will protect the
employee and re-establish a baseline.
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Information to Health Care Professionals
Healthcare professionals who administer the Hepatitis B Vaccine and vaccination series to Forest
Service employees shall be provided a copy of 29 CFR Part 1910.1030, Bloodborne Pathogens.
Health care professionals who evaluate an exposed employee after an exposure incident, shall be
provided the following information: a copy of 29 CFR Part 1910.1030, the Bloodborne
Pathogens Standard, description of the exposed employee's duties as they relate to the exposure
incident, documentation of the route(s) of exposure and circumstances. results of the source
individual's blood testing, if available and all medical records relevant to the appropriate
treatment of the employee, must include vaccination status (copies must be maintained in OPF
files).
Health Care Professional’s Written Opinion
A copy of the health care professional's written opinion shall be provided to the exposed
employee by the Forest within 15-days of the completion of the evaluation. The written opinion
shall be limited to: Hepatitis B Vaccination, whether Hepatitis B Vaccine and vaccination series
is indicated and if the employee has received such vaccination, post-exposure evaluation and
follow-up the exposed employee has been informed of the evaluation results and any other
medical conditions that result from exposure and all other findings and diagnoses shall remain
confidential and shall not be included in the written report.
COMMUNICATION OF HAZARDS TO EMPLOYEES
Labels and Signs
Biohazard labels provide a clear warning of possible exposure to BBP, a biohazard warning label
(see below) will be used when identifying containers storing potential BBP. Biohazard warning
labels will be affixed to containers of regulated waste, sharps disposal containers, refrigerators
and freezers containing blood or other potentially infectious material, and other containers used
to store, transport or ship blood, or other potentially infectious materials. Exempted from the
labeling requirement are: red bags or red containers, containers of blood, blood components, or
blood products labeling their contents and having been released for clinical use during storage,
transport, shipment or disposal.
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BIOHAZARD SYMBOL
Information and Training
Employees determined to have an occupational exposure to BBP, or other potentially infectious
materials, shall complete BBP training (Form FS 6700-16 Parts, A & B, attachments 11 & 12)
at no cost to employees, during official Government time.
Records of all training will be maintained for three years from the date of the last training. The
training will be conducted by a qualified person, who is knowledgeable in bloodborne diseases
and modes of transmission. If an employee is provided BBP training through an outside
organization (Ambulance/Fire Department) and documentation is provided, the employee will
not be required to attend Forest Service sponsored BBP training; however, training will be
provided at initial assignment to tasks where occupational exposure may take place and at least
annually thereafter. Annual training will be provided within one year of their previous training
and when changes or modification of tasks affect occupational exposure.
Training for employees determined to have an occupational exposure, will contain at a minimum
the following elements:
 Copy of OSHA Standard 29 CFR 1910.1030 for BBP and Exposure Control. General
explanation of epidemiology and symptoms of BBP.
 Explanation of the modes of transmission of BBP, explanation of the Forest exposure
control plan, and the means by which the employee can obtain a copy of the written plan.
 Explanation of the appropriate methods for recognizing tasks and other activities that
may involve exposure to blood and other potentially infectious materials.
 Explanation of the use and limitations of methods that will prevent or reduce exposure
including appropriate engineering controls, work practices, and personal protective
equipment.
 Information of the types, proper use, location, removal, handling, decontamination, and
disposal of personal protective equipment.
 An explanation of the basis for selection of personal protective equipment.
 Information on the HBV, including information on its deficiency, safety, method of
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administration, the benefits of being vaccinated, and that the vaccine and vaccination will
be offered free of charge.
Information of the appropriate actions to take and persons to contact in an emergency
involving blood or other potentially infectious materials.
Explanation of the procedure to follow if an exposure incident occurs, including the
method of reporting the incident and medical follow-up that will be made available.
Information on the post-exposure evaluation and follow-up that the Forest is required to
provide for the employee following and exposure incident.
An explanation of the signs and labels and/or coding requirements.
An opportunity for interactive questions and answers with the person conducting the
training session.
Training records will include dates of the training sessions, contents or a summary of the training
sessions, names and qualifications of persons conducting the training, names, and job titles of all
persons attending the training sessions. Training records will be maintained for three (3) years
from the date on which the training occurred. (Form FS-6700-16 parts A and B, attachment 11
& 12)
MEDICAL RECORDKEEPING
The supervisor shall establish and maintain an accurate record for each employee with
occupational exposure. This record shall include the name and social security number of the
employee; a copy of the employee's HBV status, including the dates of all the Hepatitis B
Vaccinations; and any medical records relative to the employee's ability to receive vaccination.
Records shall also include a copy of all results of examinations, medical testing, and follow-up
procedures, as required with the information provided to the healthcare professional. Employee
medical files will not be supervised and/or maintained at the district level.
All confidential medical correspondence will be managed and maintained by the designated
health care provider, located at Albuquerque Service Center (ASC) Human Capital Management
(HCM) Medical Records section and the affected employee, specifically unless otherwise
required by law. Records should be provided to the Forest Safety Officer in a confidential mail
envelope addressed to: ASC – HCM Medical Records. All employee medical records will be
received and maintained by the ASC – HCM, where Official Personnel Folders are maintained.
Availability
The Forest will ensure all records required to be maintained by this plan will be made available
upon request.
Employee training records required by this plan will be provided upon request for examination
and copied to employees, to employee representatives, and to the Forest Supervisor.
Employee medical records required by this plan will be provided upon request for examination
and copying to the subject employee, to anyone having written consent of the subject employee,
and to the Forest Supervisor.
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Transfer of Records
The supervisor shall comply with the requirements involving transfer of records set forth in 29
CFR 1910.1020(h) and shall ensure employee medical records are keep confidential, are not
disclosed or reported without the employee's express written consent to any person internal or
external to the workplace, except as required by law. The records shall be maintained for at least
the duration of employment plus 30 years in accordance with 29 CFR 1910.1030. Employee
medical records required by this plan will be provided upon request for examination and copying
to the subject employee, to anyone having written consent of the subject employee or designated
representative.
Safety and Health Information Portal System (SHIPS)
The immediate supervisor of an exposure incident employee shall ensure the incident is entered
into the Safety and Health Information Portal System (SHIPS) within 5 calendar days. The
illness category should be selected for the SHIPS entry. Questions about the use of SHIPS to
report exposure incidents can be directed to the Forest Safety Officer.
Supervisors shall ensure original bloodborne pathogen occupational exposure documents are
provided to the Forest Safety Officer. The Forest Safety Officer will ensure occupational
exposure to bloodborne pathogens related documents are submitted to the Albuquerque Service
Center-Human Capital Management (ASC-HCM).
Albuquerque Service Center-Human Capital Management
Attn: Medical Records
3900 Masthead NE
Mailstop 118
Albuquerque, NM 87109
Effective Dates
This plan becomes effective upon signature of the Forest Supervisor, Los Padres National Forest.
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HEPATITIS "B" VACCINATION RECORD
and CONSENT FORM
I have read the information about Hepatitis B and the Hepatitis B vaccine. I have had the
opportunity to ask questions and understand the benefits and risks of Hepatitis B immunization.
I agree to receive the three doses required for optimum immune response. However, as with all
medical treatment, I understand there is no guarantee I will become immune or that I will not
experience adverse side effects from the vaccine.
________________________________________
Print name of person receiving vaccination
______________________
Social Security Number
________________________________________
Signature of person receiving vaccination
______________________
Signature of Witness
______________________
Date
______________________
Date
HEPATITIS B VACCINATION PLANNING AND TRACKING
For Employee Use
Primary Dose
Second Dose (Primary + 1 Month)
Third Dose (Primary + 6 Months)
Date
Administered By (*) Lot#
___________ ______________________ __________
___________ ______________________ __________
___________ ______________________ __________
Additional Notes (*):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Distribution:
Original:
Forest Safety Officer for submittal to the ASC – HCM office where the
employee’s official medical file will be maintained
Copy:
Employee
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