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).
Name
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Biosafety Program Environmental Health & Safety