Appendix B

B-101 Exposure Control Plan

It has been recognized that law enforcement personnel, in the normal course of their duties may come into contact with blood or other body fluids, increasing the chances of contracting potentially harmful or fatal diseases. In accordance with the Occupational Exposure to Bloodborne Pathogens Standard (WAC 296 62 08001), the Olympia Police Department has established the following procedures for its employees. In addition, the Department will provide appropriate information and follow up care if exposure should occur, and will educate Department personnel on the modes of transmission, etiology (the study of the causes of disease), and universal precaution methodologies against both HIV (Aids) and HBV (Hepatitis B) viruses.

B-102 Employee assessment

For compliance with the Occupational Exposure to Bloodborne Pathogens Standard (WAC 296 62 08001) the following job classifications can reasonably anticipate that an exposure to blood, other body fluids, or other potentially infectious materials may occur. These listings are not intended to exclude personnel who, due to unexpected circumstances on duty, come into contact with blood or other body fluids:

Sworn Titles

Civilian Titles

Police Officer

Property/Evidence Personnel


Reserve Police Officers


Firing Range Personnel


Police Cadets


Jail Personnel

Chief of Police


B-103 Definitions

1.    Blood: Means human blood, human blood components, and products made from human blood.

2.    Bloodborne Pathogens: Means pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to hepatitis B virus (HBV) and human immunodeficiency virus (HIV).

3.    Body Fluids: Fluids that have been recognized by Centers for Disease Control (CDC) as directly linked to the transmission of HIV and/or HBV to which universal precautions apply: blood, semen, blood products, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid, amniotic fluid, and concentrated HIV or HBV viruses.

4.    Contaminated: Means the presence or reasonably anticipated presence of blood or other potentially infectious materials on an item or surface.

5.    Contaminated Sharps: Means any contaminated object that can penetrate the skin including, but not limited to, needles, scalpels, and broken glass.

6.    Decontamination: Means the use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal.

7.    Engineering Controls: Means controls(e.g. sharps disposal containers, self sheathing needles) that isolate or remove the bloodborne pathogens hazard from the workplace.

8.    Exposure Incident: Means a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee’s duties.

9.    HBV: Means Hepatitis B Virus.

10.    HIV: Means Human Immunodeficiency Virus.

11.    Licensed Healthcare Professional (HCP): Means a person whose legally permitted scope of practice allows him or her to independently perform the activities required in Hepatitis B vaccination and post exposure follow up.

12.    Mucous membrane: Meaning by way of the eyes, nose, or mouth.

13.    Non intact skin: Means skin that is dry, chapped, cracked, in rash, having abrasions, or has an open wound.

14.    Occupational Exposure: Means reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee’s duties.

15.    Other Potentially Infectious Materials (OPIM): Means human body fluids, such as:

A.    Vaginal secretion, semen, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva and body fluid that is contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids.

B.    Any unfixed tissue or organ (other that intact skin) from a human (living or dead).

C.    HIV containing cell or tissue culture medium or other solution; and blood, organs, or other tissues from experimental animals infected with HIV or HBV.

16.    Parenteral: Means piercing mucous membranes or skin barrier through such events as needle sticks, human bites, cuts, and abrasions.

17.    Personal Protective Equipment: Means specialized clothing or equipment worn by an employee for protection against a hazard. General work clothes (e.g. uniforms, pants, shirts, or blouses) are not intended to function as protective equipment.

18.    Regulated Waste: Means liquid or semi liquid blood, or other potentially infectious materials; contaminated items that would release blood or other potentially infectious materials in liquid or semi liquid state if compressed; items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling contaminated sharps; and pathological and micro biological wastes containing blood or other potentially infectious materials.

19.    Source Individual: Means any individuals, living or dead, whose blood or other potentially infectious materials may be a source of occupational exposure to the employee.

20.    Sterilize: Means the use of a physical or chemical procedure to destroy all microbial life including highly resistant bacterial endospores.

21.    Universal Precautions: These are approaches to infection control. According to the concept of Universal Precautions, all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens.

22.    Work Practice Controls: Means controls that reduce the likelihood of exposure by altering the manner in which a task is performed (e.g. prohibiting recapping of needles by a two handed technique).

B-104 Responsibilities

The City of Olympia and the Olympia Police Department are responsible for establishing policies and procedures which maximize the protection against communicable diseases for all its employees, as well as the public they serve. These policies and procedures shall meet the requirements of OSHA (WISHA) 29 CFR Part 1910. 1030. Occupational Exposure to Bloodborne Pathogens: Final Rule. published December 6, 1991. The Department shall ensure compliance with these policies and procedures with emphasis on the training of employees in the rational application of exposure control practices. In addition, the Department will make available to employees the preventive and protective measures required by these policies and procedures in order to minimize the risk of exposure and provide the treatment and evaluation for any employee experiencing an accidental occupational exposure.

B-105 Requirements and responsibilities in event of exposure

Employees shall recognize that they have responsibility for their own health and safety and to encourage other employees to work in a safe manner. Consistent with the circumstances presenting themselves, employees shall use the appropriate personal protective equipment consistent with these policies and procedures.

B-105.1 Department personnel who experience a possible exposure incident

1.    Shall wash exposed skin with soap and hot water immediately after any contact with blood or OPIM. If water is not readily available, use a germicidal hand cleaner and paper towel, then soap and hot water as soon as possible. Should any blood or OPIM enter the eyes, nose or mouth, these areas should be flushed with water immediately.

2.    Shall make an immediate verbal report of the exposure to their on duty supervisor.

3.    Shall comply with the post exposure procedures outlined in this section.

B-105.2 Immediate supervisors

Immediate supervisors shall evaluate the nature of the exposure to determine if post exposure follow-up is needed. They shall use the following guidelines to determine if an exposure incident took place.

1.    Evaluate the route(s) of the exposure and the circumstances under which the exposure incident occurred.

2.    Examine the employee to see if blood or OPIMs made contact with the skin, eye(s), mouth, non-intact skin, mucous membrane, or made parenteral contact.

3.    If an exposure incident took place, the supervisor shall make immediately available to the exposed employee a confidential medical evaluation and follow-up at Westcare Clinic located at 3000 Limited Lane. If the employee needs emergency treatment they will be taken to the nearest hospital for care. The on-duty supervisor will ensure the Post Exposure Follow-up Packet and all required information for the Health Care Professional is exchanged. If the employee desires to use their own doctor for follow-up care the Post Exposure Follow-up Packet will be given to the employee for their doctor. If the supervisor cannot determine if an exposure incident occurred or if the employee doesn’t agree that no exposure incident occurred the case will be treated as an exposure incident. All possible and all actual exposure incidents shall be documented on the Post Exposure Follow-up Checklist.

4.    The on-duty supervisor shall initiate the following action after an exposure incident occurs:

A.    Relieve the employee from their duty assignment, if needed, and arrange for immediate medical care at a clinic or hospital.

B.    Complete the following forms documenting the incident:

i.    First Report of Injury report

ii.    Communicable Disease report

These forms shall include documentation of the route(s) of exposure, the circumstances under which the exposure occurred, identification and documentation of the source, unless identification is not feasible.

C.    Shall give the employee a Post Exposure Follow-up Packet and have them read the Informed Consent for HBV and HIV blood testing. Ensure that the Post Exposure Follow- up Packet has a copy of the Communicable Disease report in it.

D.    Shall forward the Post Exposure Follow-up Packet with inclosed copies of the following to the Health Care Professional providing medical care for the employee:

i.    A copy of WAC 296-62-08001;

ii.    A description of the exposed employee’s duties as they relate to the exposure; (Communicable Disease Report form)

iii.    Documentation of the route(s) of exposure and circumstances under which the exposure occurred; (Communicable Disease Report form)

iv.    Results of the source individual’s blood testing, if available; and

v.    All medical records relevant to the appropriate treatment of the employee including vaccination status.

vi.    The Department’s letter to the HCP.

vii.    HCP written opinion form, and

viii.    The exposed employee’s blood testing consent form.

E.    Shall notify the on-duty Lieutenant and the Support Services Commander as soon as possible.

F.    Shall complete the Post-Exposure Follow-up Checklist prior to going off duty.

G.    Shall complete the Olympia Police Department’s Post Exposure Follow-up form.

H.    Forward the following to the Support Service’s Commander:

i.    First Report of Injury.

ii.    Communicable disease report.

iii.    Post Exposure Follow-up Checklist.

iv.    Post Exposure Follow-up receipt.

If the exposed employee is unable to aid in the post exposure follow-up procedures, it is the responsibility of the on duty supervisor to document the exposure incident.

B-105.3 Support Services Commander’s responsibilities

1.    Arrange for initiation of follow up treatment as prescribed by standard medical practices.

2.    Be the alternate contact person for emergency notification after normal business hours.

3.    Ensure that all medical evaluations and procedures including the Hepatitis B vaccine and vaccination series and post exposure evaluation and follow up, including prophylaxis, are made available, at no cost to the employee and at a reasonable time and place. Ensure, within 24 hours after an exposure incident, that the exposed employee actually sought medical treatment or received medical treatment. In the event medical treatment was not initiated or sought by the employee, the Support Services Commander, or their designee, shall provide additional resources to the employee by providing for immediate counseling by a Health Care Professional or the department bloodborne pathogens instructor to assist the employee in making their decision to seek treatment.

4.    Evaluations and procedures shall be provided according to current WAC (296-62-08001) rules and the recommendation of the U.S. Public Health Service current at the time these evaluations and procedures take place.

5.    In all cases of exposure incidents, notify the Health Department Director no later than seven (7) days after the exposure. In all cases where there is a source person identified or there are leads that could identify the source person, provide the information to the Health Department for source testing purposes.

6.    Assure that employees who decline to accept Hepatitis B vaccinations sign a declination statement.

7.    Provide for the confidentiality of all records and shall be responsible for screening any release of related information.

8.    Ensure that the healthcare professional evaluating an employee after an exposure incident is provided a copy of the WAC (296-62-08001) rule, a description of the exposed employee’ s duties as they relate to the exposure incident, and all medical records relevant to the appropriate treatment of the employee including vaccination status which is the responsibility of the Olympia Police Department to maintain.

9.    Obtain and provide the employee with a copy of the evaluating healthcare professional’s written opinion within 15 days of the completion of the evaluation. The healthcare professional’s written opinion for Hepatitis B vaccination shall be limited to whether Hepatitis B vaccination is indicated for the employee and if the employee has received such vaccinations.

10.    Shall make available counseling for the employee and family regarding the implications to the employee’s personal and professional life.

11.    Shall ensure that the City of Olympia Risk Manager is made aware of the exposure incident.

B-106 Record keeping responsibilities of the Support Services Commander

1.    Shall ensure the accurate recording of all exposure incidents and all post exposure follow up procedures of the department.

2.    Shall maintain a record of all exposure incidents of employees of the department for review purposes only. The records shall be limited to incident date, employee job classification, type of exposure, facts describing how the exposure took place, and documentation of post exposure follow up as required by WAC 296-62-08001 section (6)(d-f).

3.    Shall conduct a review of the exposure control plan and all occupational exposures annually. The review shall be prior to annual training of our exposure control plan. It shall consist of, but no limited to, an examination and maintenance or replacement of engineering and work practice controls. The Support Service Commander shall ensure any changes in work practices or engineering controls get incorporated in the annual training.

4.    For the purpose of preservation, in accordance with WAC 296-62-05207, the Support Services Commander shall ensure all records with respect to occupational exposure are forwarded to the employee’s personal file located in the cities Personnel Office. The Support Services Commander shall seal all reports of an occupational exposure in an envelope and mark it “CONFIDENTIAL.”

5.    Shall maintain the confidentially of all records relating to occupational exposures and ensure they are not disclosed or reported without the employee’s expressed written consent to any person or agency except as required by law. The availability of any record of an occupational exposure shall be strictly governed in accordance with WAC 296-62-052.

B-107 Immunizations and history

1.    All Department personnel shall be responsible for reporting any immunizations they receive on the Department Health History/Immunization record which will then be forwarded to the Department Support Services Commander, who will forward the information to Personnel in the employee’s confidential file.

2.    Hepatitis B vaccinations will be provided free of charge to Department personnel who are at substantial risk of directly contacting body fluids. Requests for immunizations will be handled by the Support Services Commander.

3.    Employees who participate or decline to participate in the hepatitis B vaccinations offered by the employer must sign a statement of declination or acceptance. However, the employee who declines, may at anytime choose to have the vaccinations at no cost to him/her.

B-108 Distribution of forms

The forms noted should be distributed as follows:

1.    Post-Exposure Follow-up Receipt

Original: Support Services Commander

2.    Olympia Police Department First Report of Injury/Communicable Disease Report Form

Original: Support Services Commander

Copy: Post Exposure Follow-up Packet for the H.C.P.

3.    Olympia Police Department Health History/Immunization Record

Original: Support Services Commander

4.    Olympia Police Department Hepatitis B Vaccine Participation/Declination Immunization Record

Original: Support Services Commander

5.    Olympia Police Department Post Exposure-Follow up Checklist

Original: Support Services Commander

B-109 Personal protective equipment and precautions dictated by risk level

Olympia Police Department shall make available, appropriate personal protective equipment such as, but not limited to, gloves, gowns, face shields or masks and eye protection, CPR mouthpieces, and pocket masks. Personal protective equipment will be considered appropriate only if it does not permit blood or other potentially infectious materials to pass through 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.

Incident scenes should be categorized according to the level of risk, with Level I being the lowest risk, and Level IV being the highest risk. As the level of risk increases, additional safety precautions are required. Employee are required to follow these minimum recommendations. Employees can choose to wear more protective equipment if they so desire.

1.    Level I: An incident scene where individual pieces of evidence or property suspected of being contaminated must be collected:

A.    The ten (10) work practice controls shall be followed. (See B-114)

B.    Latex gloves shall be worn.

2.    Level II: Interior or exterior scene, with little or no blood or other body fluids:

A.    The ten (10) work practice controls shall be followed. (See B-114)

B.    Latex gloves shall be worn.

3.    Level III: An incident scene where a small amount of suspected blood or other body fluids are collected, using swabs or scalpel for scrapings or anytime aerosolization or splashing of blood or body fluids is likely to occur:

A.    The ten (10) work practice controls shall be followed. (See B-114)

B.    Latex gloves shall be worn.

C.    Eye protection shall be worn. Eye protection should be sanitized following scene processing, unless they are disposable.

D.    Disposable biohazard face masks shall be worn.

4.    Level IV: Interior or exterior incident scenes with a considerable amount of blood or other body fluids or any scene containing decomposing bodies or anytime aerosolization or splashing of blood or body fluids is likely to occur:

A.    The ten (10) work practice controls shall be followed. (See B-114)

B.    Latex gloves shall be worn.

C.    Disposable biohazard face masks shall be worn.

D.    Protective disposable clothing shall be worn.

E.    Eye protection shall be worn. Eye protection devices should be sanitized following scene processing, unless they are disposable.

F.    Disposable foot coverings or rubber boots, along with disposable body covering will be worn. Rubber boots, if worn, should be sanitized following scene processing.

In the event of an emergency or exigent circumstances, the above risk levels will be adhered to as soon as reasonably possible after the situation has settled. In similar fashion, supervisors or commanders who make a brief appearance on a scene (but do not actually take part in evidence gathering, etc.) will take those precautionary measures appropriate to their level/degree of involvement. When an employee makes this judgment the circumstances shall be investigated and documented by a supervisor in order to determine whether changes can be instituted to prevent such occurrences in the future. The information should be forwarded through the chain of command to the Support Services Commander using the Post Exposure Follow-up Checklist.

B-110 Evidence handling procedures for items contaminated with potentially infected materials

For the protection of all personnel, biohazardous evidence must be packaged and labeled properly to prevent exposure to others. All evidence involving blood, body fluids, clothing and other items which may have been contaminated by any of the above will be considered and handled as biohazardous evidence. The following procedures apply to the initial examination and preparation of evidence and the storing of evidence suspected of being contaminated with blood or other body fluids.

1.    No item of evidence suspected of being contaminated, no matter how large or small, is to be handled without latex gloves. Certain items or situations may require additional protection, such as Tyvek suits, shoe covers, masks and/or eye protection. Evidentiary items which require laboratory processing should be handled in accordance with standard operating procedures of the Evidence Section. Bags and containers with such materials should be marked with tags or otherwise identified as containing infectious waste in accordance with the Occupational Exposure to Bloodborne Pathogens standard (WAC 296 62-08001).

2.    No contaminated evidence, regardless of size, should be placed in direct contact with table tops or other non contaminated surfaces. Wrapping paper, paper bags, drop cloths, or other coverings shall be used as surface coverings. When air drying, wrapping paper should be draped around the item and then marked with biohazardous stickers/labels. Gloves, eye protection and masks should be worn when air drying and packaging the evidence.

3.    Items to be transported to the Evidence section for drying and/or storing should be placed in a red “biohazard” bag then placed in a paper bag (double bagged if necessary) to prevent leakage during processing, transport and storage. The bag should then be sealed with staples and labeled with the required “biohazard” tags.

4.    Syringes and needles shall be placed in the puncture and breakage resistant Disposable Sharps Collector. If placement into evidence is necessary, needles shall not be recapped, purposely bent or broken by hand, removed from disposable syringes or otherwise manipulated by hand. If the syringe needs to be kept intact, place the needle in the Needle/Syringe Keeper using the one handed method and transport to the Evidence section.

5.    All other sharp items such as scissors, knives, scalpels, razors, broken glass, nails, etc. will be protectively covered and labeled “sharp instrument.” If the items are of evidentiary value, and have blood or body fluids on them, the item(s) will need to be air dried once in evidence and double bagged in paper bags. The bag should then be appropriately labeled “biohazard” and stored according to the standard operating procedures of the Evidence Section. If they are not of evidentiary value, the item should be packaged in a red “biohazard” bag and placed in a paper bag (double bagged if necessary) to prevent leakage. The bag should then be sealed with staples and labeled with the required “biohazard” tags. The bags should be placed in evidence and labeled “To Be Destroyed”.

6.    Officers should be aware that they are ultimately responsible to safely package items submitted to Evidence to ensure that no one will be contaminated. Biologically contaminated evidence or other items presenting potential hazards to Evidence personnel (e.g. sharps, weapons, etc.) will be made available for viewing by the Evidence personnel, or the on-duty supervisor if the Evidence Officer is unavailable, prior to acceptance into the Evidence Section. Evidence should refuse any item that is not properly packaged. In cases of dispute, the Officer’s immediate supervisor will be contacted to arbitrate.

B-111 Cleaning of contaminated areas and equipment

1.    Community items or reusable items, such as pens, typewriters, telephones, portable radios, handcuffs etc. should not be touched with contaminated gloves. Gloves should be changed each time before one of these items is used unless extreme care is taken to decontaminate the these items when you are finished using them. Transporting contaminated reusable items shall be done using a biohazard bag until decontamination is completed.

2.    Once evidence is removed from the preparation area, the work area to be promptly and properly cleaned and disinfected according to the procedures outlined in the Exposure Control Plan.

3.    Disposal of contaminated cleaning materials (i.e. bloody towels, cloths, dressings, wrapping paper, wound wipes etc.) or other waste material not for evidence must be disposed of in the red “biohazard” bags located in each precinct. The bags shall then be placed into evidence shed and labeled for destruction. A note shall be written for the Evidence Technician to dispose of the bag(s).

4.    All areas of police vehicles contaminated with biological hazards will be thoroughly cleaned by the officer using the vehicle as soon as possible with an approved decontaminate (e.g. bleach/water solution, disinfectant, virucide) before continuation of or return to service. If the vehicle is contaminated to the degree requiring extensive cleaning it shall be taken off the line to be cleaned later by our Cadets. Police vehicles so contaminated should be considered out of service until this cleaning is accomplished. The Watch Commander shall make the decision to take a vehicle of the line.

B-112 Regulated Waste

1.    During use, disposable sharps containers shall be easily accessible to personnel and located as close as feasible to the immediate area where sharps are used or can be reasonably anticipated to be found. Disposable sharps containers shall be placed nearby the prisoner holding cell areas of the Olympia Police facilities. In addition, Patrol Sergeants shall carry a sharps container provided by the Evidence Section (which meet OSHA/WISHA standards) in the trunk of their assigned vehicles for access to Patrol Officers in the field.

2.    Evidence personnel and/or Supervisors shall ensure that the containers do not overfill and are routinely replaced. Containers of contaminated sharps shall be closed immediately prior to removal or replacement to prevent spillage or protrusion of contents during handling, storage or transport. If leakage is possible, containers shall be placed in a secondary container which is closeable and constructed to contain all contents of the primary container during storage or transport. Containers shall be disposed of by the Evidence Officer.

3.    Contaminated laundry shall be handled as little as possible with a minimum of agitation. Contaminated laundry that is wet or presents a likelihood of soak through shall be bagged at the location where it was used and shall not be sorted or rinsed in the location of use. Uniforms contaminated shall be labeled with biohazard label to alert cleaning agencies of the potential contamination. Contaminated clothing must not be cleaned at home. All contaminated uniforms shall be placed into the outside evidence storage locker for cleaning. Contaminated Jail laundry shall be washed in the Olympia Police Department washing machine.

B-113 Training

1.    The department shall ensure that all employees with occupational exposure participate in a training program which must be provided at no cost to the employee and during working hours.

2.    Training shall be provided as follows:

A.    At the time of initial assignment to tasks where occupational exposure may take place;

B.    Within 90 days after the effective date of the standard; and

C.    At least annually thereafter. Annual training for all employees shall be provided within one year of their previous training.

3.    The training program shall contain at a minimum the following elements:

A.    An accessible copy of the regulatory text of this standard and an explanation of its contents;

B.    A general explanation of the epidemiology and symptoms of bloodborne diseases;

C.    An explanation of the modes of transmission of bloodborne pathogens;

D.    An explanation of the department’s exposure control plan and the means by which the employee can obtain a copy of the written plan;

E.    An explanation of the appropriate methods for recognizing tasks and other activities that may involve exposure to blood and other potentially infectious materials;

F.    An explanation of the use and limitations of methods that will prevent or reduce exposure including appropriate engineering controls, work practices, and personal protective equipment;

G.    Information on the types, proper use, location, removal, handling, decontamination and disposal of personal protective equipment;

H.    An explanation of the basis for selection of personal protective equipment;

I.    Information on the hepatitis B vaccine, including information on its efficacy, safety, method of administration, the benefits of being vaccinated, and that the vaccine and vaccination will be offered free of charge;

J.    Information on the appropriate actions to take and persons to contact in an emergency involving blood or other potentially infectious materials;

K.    An explanation of the procedure to follow if an exposure incident occurs, including the method of reporting the incident and the medical follow-up that will be made available;

L.    Information on the post-exposure evaluation and follow-up that the employer is required to provide for the employee following an exposure incident;

M.    An explanation of the signs and labels and/or color coding required by WAC 296-62-08001 (7) (a); and

N.    An opportunity for interactive questions and answers with the person conducting the training session.

4.    The department will review each exposure incident yearly and shall provide additional training when changes such as modification of tasks or procedures or institution of new tasks or procedures affect the employee’s occupational exposure. The additional training may be limited to addressing the new exposures created or revisions to work practices.

5.    Training record keeping:

A.    Training records shall include the following information:

i.    The dates of the training sessions;

ii.    The contents or a summary of the training sessions;

iii.    The names and qualifications of persons conducting the training; and

iv.    The names and job titles of all persons attending the training sessions.

B.    Training records shall be maintained for 3 years from the date on which the training occurred.

6.    Availability of training records:

A.    All training records will be made available, upon request, to the Director of Labor and Industries for examination and copying.

B.    Employee training records required by this section shall be provided upon request for examination and copying to employees, to employee representatives, or to Labor and Industries in accordance with WAC 296-62-052.

C.    Employee medical records required by this section shall be provided upon request for examination and copying to the subject employee, to anyone having written consent of the subject employee, or to the Director of Labor and Industries in accordance with WAC 296-62-052.

7.    Transfer of Records:

A.    The department shall comply with the requirements involving transfer of records set forth in WAC 296-62-052.

B.    If the department ceases to do business and there is no successor employer to receive and retain the records for the prescribed period, the department shall notify Labor and Industries at least three months prior to their disposal and transmit them to Labor and Industries, if required by the Director of L&I to do so, within that three month period.

B-114 Work Practice Controls

1.    No eating, drinking, smoking, application of cosmetics or lip balm or handling of contact lenses will be allowed in areas where there is a risk or occupational exposure.

2.    No food/beverages shall be kept in refrigerators or other locations where blood or Other Potentially Infectious Materials (OPIM) are present.

3.    If contact with blood or OPIM is expected, employees are to examine themselves for cuts, sores, hangnails, abrasions and cover them with a sterile bandage.

4.    After the removal of gloves or other personal protective equipment, employees shall wash their hands immediately. (or as soon as possible)

5.    Employees shall wash exposed skin with soap and hot water immediately after any contact with blood or OPIM. If water is not readily available, use a germicidal hand cleaner and paper towel, then soap and hot water as soon as possible. Should any blood or OPIM enter the eyes, nose or mouth, these areas should be flushed with water immediately.

6.    Contaminated needles and other sharps shall not be bent, recapped or removed. Shearing or breaking of sharps is prohibited.

7.    SHARPS CONTAINERS or SHARPS/NEEDLE KEEPERS are located at the precincts and in the Sergeants’ vehicles. These are puncture resistant, labeled/color coded as BIOHAZARD, and leak proof.

8.    Evidence or impounded items which are contaminated with blood or OPIM shall be packaged in appropriate leak proof containers and labeled BIOHAZARD. Any item collected which may puncture the first bag shall be double bagged so as to prevent puncturing/leaking.

9.    BIOHAZARD waste (gloves, masks, boxes, etc.) that is contaminated with blood or OPIM shall be appropriately packaged and disposed of in the red plastic biohazard bags, then placed in evidence for disposal.

10.    Reusable items/equipment Handcuffs, pens, etc.) which are contaminated with blood or OPIM shall be decontaminated as soon as possible.



Employee Name ______________________________________________ ID # _____________

Social Security # _____/_____/________ Birthdate ___/___/___ Unit # __________________

Communicable Disease History:

Varicella Zoster (Chickenpox)


Rubeola (Measles )




Rubella (German Measles)


Hepatitis B




Immunization Record:

Specify dates for





















Hepatitis B:

Immune Status __________

Test Date/Time ___________________________


Dose 1 _________________

Date/Time _______________________________


Dose 2 _________________

Date/Time _______________________________


Dose 3 _________________

Date/Time _______________________________


Post HBV Antibody Status __________________________________________

Tuberculosis Skin Test:











if neg

if neg

if neg

if neg











X Ray date (positive test) ____________ Test Administered by ________________________


Original to employee’s confidential personnel file



I understand that due to an occupational exposure to blood or other potentially infectious materials or people, I may be at risk of acquiring the Hepatitis B virus (HBV) or Tuberculosis (TB) infection. I have been given the opportunity to be vaccinated with Hepatitis B vaccine and be tested for the Tuberculosis infection, at no charge to myself. However, I decline Hepatitis B vaccination and/or the Tuberculosis skin test at this time. I understand that by declining this vaccine or skin test, I continue to be at risk of acquiring Hepatitis B or Tuberculosis, serious diseases. If in the future I continue to have occupational exposure to blood or other potentially infectious materials or Tuberculosis and I want to be vaccinated with Hepatitis B vaccine or participate in the TB skin test program, I may receive the vaccination series and testing at no charge to me.

After evaluating the advantages and disadvantages of the vaccine and skin testing programs, based on the training provided, I elect to: (check one)

1.    Hepatitis B Immunization Program:

____Participate ____Not Participate

2.    Tuberculosis Surveillance Program:

____Participate ____Not Participate

in the Olympia Police Department’s Hepatitis B Immunization Program and/or the Tuberculosis Surveillance Program. My choice not to participate in no way affects my employment status.

Dated this _____ day of ___________ , _______

Employee Name ______________________________________________ Serial # __________

Employee Signature _____________________________________________________________

Witness _______________________________________________________________________

Original to employee’s confidential personnel file


NAME:______________________________________ DIVISION:_______________________

CASE NUMBER:______________________________ REPORT DATE:__________________

INJURY DATE: _______________________ TIME OF INJURY:________________________

LOCATION OF INJURY:________________________________________________________

EXTENT OF INJURY:__________________________________________________________

CIRCUMSTANCES OF INJURY:_________________________________________________





PLACE OF TREATMENT:_______________________________________________________

DATE OF TREATMENT:______________________________

TYPE OF TREATMENT:________________________________________________________

DOCTOR’S/MEDIC’S NAME:____________________________________________________

WITNESSES TO INJURY:_______________________________________________________


OFFICER’S SIGNATURE:________________________________________________________

SUPERVISOR’S COMMENTS:___________________________________________________


SUPERVISOR’S SIGNATURE:___________________________________________________

CHIEF’S SIGNATURE:__________________________________________________________


NOTE: This form shall be treated confidentially as a medical record. Complete records of testing and treatment shall be maintained by attending physician for release only as authorized by law.

A.    Employee Information

Name (Last, First, Middle): _______________________________________________________

Address: ______________________________________________________________________

Phone (Home)_____________________________ (Work)_____________________________

Incident #: __________________________ Incident date/time: _________________________

Date/time of verbal report: ________________________________________________________

Supervisor receiving report: _______________________________________________________

Describe exposure: ______________________________________________________________

Employee received treatment from: _________________________________________________

Employee referred to: ___________________________________________________________

Employee’s HBV vaccination status: ___ Yes they’ve had it ___No they haven’t

Previous tuberculosis skin test results: ___ Negative result ___ Positive result

Date of last skin test: ______________________

Patient Information:

Name: ________________________________________________ Date of Birth: __________

Address: ____________________________________________ Phone #: ________________

Patient taken to (loc.): ___________________________________________________________

Exposure report phoned to: ___________________ Date/time of report: __________________

Patient consented to HIV and HBV blood testing: ___Yes ___No.

If no consent, supervisor informed (name): ___________________________________________

Date/time supervisor informed___________________________

Px/blood sample (sent to Health Dept. Lab) date/time: __________________________________

Source Person unable to be identified for following reason(s):____________________________


Original to employee’s confidential personnel file

Copy to Post-Exposure Follow-up Packet for the HCP



I understand that during contact with an Olympia Police Department employee, that person was exposed to my blood or body fluids. In order to provide this employee with appropriate counseling and treatment, the hospital recommends that my blood be tested for the HIV antibody (the virus which causes AIDS), and for the virus which causes Hepatitis B. The test results may also assist me in making decisions regarding my own medical care. I will not be charged for the test.

WHO WILL GET THE TEST RESULTS: I understand the results of this blood test will be provided to my doctor, but will not be placed in my hospital medical record. I can contact my physician for my test results. I am aware that the test results will also be given to the Olympia Police Department, who will share the results with the employee. Except for the above, the hospital, to the best of its ability, will not disclose the results of the test without my specific authorization.

INFORMATION ABOUT THE TEST: I understand that blood tests are not 100% accurate. I have received information about the test, including the benefits and disadvantages of testing. I have had a chance to ask questions and my questions have been answered. I understand that post-test counseling is available through my private physician.

AUTHORIZATION: I authorize Hospital to test my blood for HIV antibody and for Hepatitis B, and to disclose the test results as reasonably required in connection with counseling and follow-up to the employee involved in a blood or body fluid exposure, and to my physician for my own treatment and benefit.

Signature of Patient: _____________________________ Date: __________________

Witness: ____________________________________________ Date: _____________________

Copy to Support Services Commander




Source patient consent information for HIV and Hepatitis B testing following an exposure to employee

You have become the source of a blood or body fluid exposure to an employee of the Olympia Police Department. As the source patient, we are asking you to read the information below and to agree to be tested for the HIV antibody, and for the virus which causes Hepatitis B. This information will assist us in providing the appropriate care for the involved employee.

ABOUT THE DISEASE: Various diseases can be transmitted through blood and certain body fluids. One of these diseases is Acquired Immune Deficiency Syndrome (AIDS). Aids is caused by Human Immunodeficiency Virus (HIV), which damages the immune system of an infected person, leaving that person vulnerable to attack by certain infections and cancers. There is currently no cure. Another disease which can be transmitted through blood and body fluids is Hepatitis B. This disease, also caused by a virus, affects the liver and can cause serious damage and even death.

Police Department employees are at risk of acquiring these diseases if exposed either by direct contact to their own blood system, e.g.: needle stick from used needle, blood splash to an open wound, used scalpel wound, or blood or body fluid splash to mucous membranes. If an exposure does occur, the employee is asked to consider HIV testing over a period of six months. Along with their own testing, OSHA (Occupational Safety and Health Administration), has mandated that all source patients also be tested, after obtaining informed consent, as part of the follow-up to an exposure.

HOW HIV AND HEPATITIS B ARE TRANSMITTED: You cannot get HIV or Hepatitis B by normal social contact with a person who has the virus, e.g.: eating in a restaurant, hugging, holding hands. Both viruses are found in body fluids, including blood, semen, vaginal fluids, and occasionally breast milk. The virus most often is spread by sexual activity, needle sharing, and from an infected mother to her unborn child.

TEST CHARGES: The test for HIV and Hepatitis B will be not be charged to you. An order for the tests will not appear on your medical record. The results will be sent to your personal physician, who can provide you with your results, and to the Olympia Police Department and the employee exposed. The involved employee will be made aware of the results after signing a confidentiality statement. The results will then be placed in the involved employee’s confidential health record.

TESTING PHILOSOPHY: We ask you not to consider this request of testing as a personal evaluation of your lifestyle. At St. Peter’s Hospital, all patients’ blood and body fluids are considered as potentially infectious and all exposures are handled in the same manner.

ABOUT HIV AND HEPATITIS B TESTS: A blood test has been developed to detect antibodies to HIV. The tests detect the body’s reaction to the virus and not the virus itself.

Persons who have a positive HIV antibody test are assumed to carry the virus. They can spread the disease to others by sexual, blood, or other body fluid contact. When a person tests positive to HIV, this does not mean they have AIDS. A certain number of these people will get AIDS in the future, but no one knows how many.

If a person tests negative, it usually means that the person has never been infected with HIV, but it is possible that infection has occurred and the body has not had time to develop antibodies. In most cases, the blood test becomes positive within three months after infection. If tested prior to this time, an infected individual could test negative. For this reason, it is possible your physician might request that you be tested again at a later date.

A test has also been developed to test for the Hepatitis B virus. If a person tests positive to the Hepatitis B virus, it means that person is infected by the virus and able to transmit the virus via blood and certain body fluids to another individual.

ACCURACY OF THE TEST: No test is 100% accurate.

ADVANTAGES OF BEING TESTED: The antibody tests are used by physicians to determine if a patient is infected with HIV or Hepatitis B. The test results can be used to counsel individuals about reducing their risk of exposure to the virus, and, if positive, reducing the risk of spreading the virus to others. It is also useful in determining appropriate follow-up treatment for a Police Department employee exposed to blood or other body fluids.

DISADVANTAGES OF BEING TESTED: For some persons, there may be stress, anxiety, or depression associated with learning test results. Knowledge of test results has, in some instances, led to prejudice and discrimination, loss of job, housing, or insurance, unavailability of new health insurance, or other adverse effects. Prejudice and discrimination related to employment, housing, and current insurance are punishable by law.



Date______________ Case Number________________

Type of call: ___________________________________________________________________

Name of witnesses: ______________________________________________________________

Personal Protective Equipment used?



Equipment used: ___________________________________________






Reason why equipment not used: ______________________________





Exposure Incident? ___Yes ___No

Reason for determination:_________________________________________________________



Route(s) of exposure:____________________________________________________________






Support Services Commander notified? ___Yes ___No


If “no,” was the Support Services Lieutenant notified? ___Yes ___No

Employee relieved of duty assignment? ___Yes ___No

Did the employee receive medical treatment? ___Yes ___No


If “yes,” name of HCP and facility: ___________________________________________

Was the employee referred to a health care professional? ___Yes ___No


If “yes,” name of HCP and facility: ___________________________________________

DOCUMENTATION: (Attach all completed forms)

City of Olympia Injury/Accident report? ___Yes ___No

First Report of Injury? ___Yes ___No

Communicable Disease Report? ___Yes ___No

Olympia Police Department Consent for Blood Testing? ___Yes ___No

Source Person Documentation:

Source Person(s) Identified? ___Yes ___No

Source Person(s) consent form for blood testing? ___Yes ___No

Location of Source Person’s testing_________________________________________________

Documents given to HCP:

Copy of WAC 296-62-08001? ___Yes ___No

Description of exposed employee’s duties as related to this exposure incident? ___Yes ___No

Documentation of the route(s) of exposure? ___Yes ___No

Results of source persons testing (if known): ___Not known ___Yes ___No

HBV vaccination status of employee? ___Yes ___No

Signature of Supervisor: ________________________________ Date/Time: _______________


Did employee receive medical treatment? ___Yes ___No

Was Health Department notified of Source Person? ___Yes ___No

Is Health Department providing Source Person testing? ___Yes ___No

Is the Health Department seeking court ordered source testing? ___Yes ___No
















Support Services Commander (or designee): _________________________________________

Date: ____________________


Post exposure follow-up receipt

I, ____________________________________, acknowledge receiving the Post Exposure Follow-up Packet from my supervisor. I will follow through with post exposure medical treatment with Westcare Clinic or any other Health Care Professional of my choosing within 24 hours from the time of my exposure. I will give the Olympia Police Department’s Post Exposure Packet to the Health Care Professional treating me.

Signature of Employee: _______________________________ Date/Time: ________________

Signature of Supervisor: _______________________________ Date/Time: ________________