Needle Recapping Exclusion Form

Name
First Last
Email
Phone
Department:
Building/Room(s):
Recapping Procedures
How many procedures will need exclusions?
(Enter a number).
Describe procedure requiring recapping:
Will this exclusion be type "1" or "2" as defined below?
- Type 1: If the syringe must be used as the "sample container" or inoculations must be prepared in advance.
- Type 2: If the environmental conditions are such that failure to recap the needle would create a more hazardous situation for personnel or animals present (i.e., animal is poorly restrained, sharps container cannot be placed/maintained within arm's reach).
Explanation of factor(s) that prohibits immediate disposal of uncapped device in a sharps container.
(Note: If the conditions of the procedure do not warrant the practice of recapping, then you must not do so. If you do, sharps injuries may occur and/or this action can be cited by safety and research compliance inspectors as an unsafe action, regardless of the applicability of the OSHA Bloodborne Pathogens Standard).
Phone
This field is for validation purposes and should be left unchanged.

Biosafety Program Environmental Health & Safety