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  Self-Assessment Guidance Card                   

  **Area**: **Bloodborne Pathogens (BBP)**        **Date**: 01/30/08

  **Topic**: Line Organization                    **Rev**: Final Rev0
  [planned]{.underline} work/role resulting in    
  contact with BBP                                

  **References**: OSHA 1910.1030 via SBMS         
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| **Performance Expectations**:                                         |
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| 1.  Have *[exposure control]{.underline}* documents been developed    |
|     for this work done with BBP by the organization?                  |
|                                                                       |
| 2.  Has the *[exposure control]{.underline}* document been reviewed   |
|     (at least annually) for currency with OSHA 1910.1030 Blood borne  |
|     Pathogen?                                                         |
|                                                                       |
|     a.  Has the document's date been changed to reflect the annual    |
|         review?                                                       |
|                                                                       |
|     b.  Has the topic of control measures been researched in the last |
|         year so that new developments in control technology can be    |
|         included if feasible?                                         |
|                                                                       |
| 3.  Have potentially exposed workers received annual training?        |
|                                                                       |
| 4.  Are potentially exposed workers in the medical surveillance       |
|     requirements established by the OMC via the [Job Assessment Form  |
|     (JAF)](http://www.bnl.gov/HR/OCCMED/linkable_files/doc/JAF.doc)?  |
|                                                                       |
| 5.  Have workers with potential exposure been offered the Hepatitis B |
|     vaccination series?                                               |
|                                                                       |
| 6.  Are containers of blood, other potentially infectious material,   |
|     and contaminated material, PPE, and clothing labeled with the     |
|     [Biohazard                                                        |
|     Label](https://sbms.bnl.gov/sbmsearch/subjarea/115/115_exh1.cfm)? |
|                                                                       |
| 7.  Are blood and other potentially infectious material, disposable   |
|     protective clothing, and contaminated material disposed of per    |
|     the [Regulated Medical Waste                                      |
|     Management](https://sbms.bnl.gov/sbmsearch/subjarea/20/20_sa.cfm) |
|     Subject Area?                                                     |
|                                                                       |
| 8.  Were exposure events occurring in the last year handled and       |
|     investigated as per Section 3 of the Subject Area?                |
|                                                                       |
| 9.  Were sharps cuts/needle sticks (percutaneous injuries) reported   |
|     to the SHSD Safety Engineering Group for the sharps injury log?   |
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| Procedure: *(Perform the following as applicable for the assessment)* |
|                                                                       |
| -   Review assessment guidance card.                                  |
|                                                                       |
| -   Review applicable procedure/requirements.                         |
|                                                                       |
| -   Observe the activity controlled by the procedure.                 |
|                                                                       |
| -   Interview appropriate personnel about requirements and practices. |
|                                                                       |
| -   Record observations based on comparison to guidance.              |
|                                                                       |
| -   Document the results.                                             |
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+-----------------------------------------------+----------------------+
| **Basis for the Assessment**: *(Why is the    |                      |
| assessment being done?)*                      |                      |
|                                               |                      |
| Periodic Lessons Learned Directed by          |                      |
| Management Responsive Targeted                |                      |
+-----------------------------------------------+----------------------+
| **Assessor(s)**:                              | **Date of            |
|                                               | Assessment**:        |
+-----------------------------------------------+----------------------+
| **Location of Assessment**: *(Bldg/Room)*     |                      |
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