• Bloodborne Pathogens

  • There are 3 sections to this form: 

    1. Contact Information
    2. Vaccine Declaration and Titer
    3. Bloodborne Pathogen Quiz
      1. Please review this video prior to taking the Bloodborne Pathogen Quiz. 

    Please complete all 3 sections. 

     

    Note: If you have already received the Hep B vaccination series and do not wish to get a titer, please select "Vaccine Declination" in the second section of this form.

  • VOLUNTEER INFORMATION

  • I volunteer as:*
  • Format: (000) 000-0000.

  • HEPATITIS B VACCINATION AND TITER

    Note: If you have already received the Hep B vaccination series and do not wish to get a titer, please select "Vaccine Declination".
  • Please choose one of the following options:*
  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • QUIZ

    Blood Borne Pathogen Review Questions
  • An infectious disease:*
  • Pathogens can enter your body through:*
  • Pathogens may be present in bodily fluids other than blood.*
  • Take Standard Precautions:*
  • Standard Precautions Include:*
  • Personal Protective Equipment (PPE) include:*
  • To clean a spill of bodily fluids:*
  • If the bodily fluids soil your clothing, you can place the soiled item in a biohazard bag and give it to your supervisor for cleaning.*
  • If you feel you have received a pathogen exposure, report the incident to your supervisor:*
  • The Three Rivers Park District offers the _________ vaccine series to its employees and volunteers who may come into contact with blood borne pathogens.*
  • Be sure to wash your hands thoroughly*
  • Questions about Pathogens, Standard Precautions and possible exposure incidents can be answered by consulting:*
  • Should be Empty: