Bloodborne Pathogens

and Long-Term Care

Workers

U.S. Department of Labor

Occupational Safety and Health Administration

OSHA 3131

1992
The information contained in this publication is not considered a substitute for any

provisions of the Occupational Safety and Health (OSH) Act of 1970 or for any

standards issued by OSHA.

Material contained in this publication is in the public domain and may be reproduced,

fully or partially, without permission of the Federal Government. Source credit is

requested but not required.

This information will be made available to sensory impaired individuals upon request.

Voice phone: (202) 523-0013;

TDD message referral phone: 1-000-326-2577
Bloodborne Pathogens

and Long-Term Care

Workers

U.S. Department of Labor

Lynn Martin, Secretary

Occupational Safety and Health Administration

Doroth L. Strunk, Acting Assistant Secretary

OSHA 3131

1992

Contents

Page

Introduction ...................................................................................... 1

Who Is Covered?.............................................................................. 3

Exposure Control Plan ................................................................... 4

Who Has Occupational Exposure?...............................................4

Communicating Hazards to Employees...................................... 5

Preventive Measures.........................................................................6

Hepatitis B Vaccination....................................................................6

Universal Precautions .....................................................................7

Methods of Control ...........................................................................7

Engineering and Work Practice Controls...................................... 7

Personal Protective Equipment .................................................... 10

Housekeeping ................................................................................. 12

Equipment ..................................................................................... 12

Waste ............................................................................................. 12

Laundry ......................................................................................... 13

What to Do if a n Exposure incident Occurs .................................. 14

Recordkeeping ..................................................................................... 15

Other Sources of Assistance ....................................................... 16

Consultation Programs ................................................................. 16

Voluntary Protection Programs ................................................... 17

Training and Education ................................................................. 17

Appendix A--Declination Statement ..................................................... 13

Appendix B-OSHA Consultation Project Directory ............................. 19

States with Approved Plans ............................................................ 21

Related Publications ............................................................................. 24

Illustrations

Table 1 - Compliance Calendar .......................................................2

Table 2 - Labeling Requirements .....................................................9

Figure 1 - Biohazard Symbol ..................................................................10

iii

Introduction

Long-term health care workers face a variety of hazards in their work. These hazards

can result in back injuries, slips and falls, "burnout," or the effects of shiftwork.

Recently, the risks from exposure to bloodborne pathogens, such as human

immunodeficiency (HIV) and hepatitis B (HBV) viruses, have become a concern.

According to Occupational Safety and Health Administration (OSHA) estimates, more

than 5.6 million workers in health care and related occupations could be potentially

exposed to these viruses.*

Long-term health care workers provide services to patients in nursing homes, hospices,

mental institutions and home-care settings, and they care for people with long-term

illnesses, such as cancer and AIDS. Consequently, these workers perform daily tasks

that expose them to blood and other potentially infectious materials--such as

administering insulin or other injections, using equipment to suction patients' lungs to

help them breathe, and changing linens or dressings soiled by bed sores or other open

wounds.

OSHA recognizes the need for a regulation to protect these workers against the health

hazards of exposure to blood and other potentially infectious materials, including

bloodborne pathogens, and to reduce their risk to this exposure.

This booklet is designed to assist health care workers in long-term care settings to

understand and to comply with OSHA's new regulation on bloodborne pathogens,

published on December 6, 1991, in the Federal Register under Title 29 Code of Federal

Regulations, Part1910.1030, and effective March 6, 1992 (see Table 1 for compliance

calendar.)

This booklet outlines and summarizes the requirements of the standard** and informs

tong-term health care workers of the risks of occupational exposure to bloodborne

pathogens and how to reduce these risks.

*OSHA, Office of Regulatory Analysis, 1991.

**This booklet is not a substitute for requirements of the a standard. The complete

bloodborne pathogens regulatory text and appendix with an explanatory preamble was

published in the Federal Register 56(235):64004-64182 on December 6, 1991.

1
Tab1e 1. Compliance Calendar

Effective Date of the Standard 3/6/92

Exposure Control Plan 5/5/92

Information and Training

of Employee Hazard Communication 6/4/92

Recordkeeping 6/4/92

Engineering/Work Practices 7/6/92

Personal Protective Equipment 7/6/92

Hepatitis B Vaccination and

Post-Exposure Follow up 7/6/92

Labels and Signs 7/6/92

Housekeeping 7/6/92

Other Provisions 7/6/92

2
Who is Covered?

The OSHA standard protects all employees who may reasonably anticipate being

occupationally exposed to blood and other potentially infectious materials. Coverage

includes, but is not limited to, employees such as registered nurses, nurse assistants,

laundry workers, licensed practical nurses, housekeepers, physical therapists, and others

who may be long-term health care workers.

Occupational exposure means a “reasonable anticipated skin, eye, mucous membrane,

or parenteral contact with blood or other potentially infectious materials that may result

from the performance of the employee’s duties.”

Blood means human blood, blood products, or blood components. Other potentially

infectious materials include human body fluids such as semen; vaginal secretions;

cerebrospinal, synovial, pleural, pericardial, peritoneal, and amniotic fluids; saliva in

dental procedures; body fluid visibly contaminated with blood; unfixed tissues or

organs; HIV-containing cell or tissue cultures; and HIV or HBV-containing culture

medium or other solutions.

Federal OSHA authority extends to all private sector employers with one or more

employees, as well as to civilian employees of the federal government. In addition,

many states administer their own occupational safety and health programs through

plans approved under section 18(b) of the OSH Act. These states must adopt standards

and enforce requirements that are at least as effective as federal requirements. Of the

current 25 state plan states, 23 cover the private and public (state and local

governments) sectors and 2 cover the public sector* only(see Appendix B at the end of

this booklet).

The bloodborne pathogens standard describes how to determine who is covered and the

ways to reduce workplace exposure to bloodborne pathogens. The first step is a written

exposure control plan.

*Public sector employees in non-state plan states have neither federal nor state coverage

under the rule.

3
Exposure Control Plan

OSHA's bloodborne pathogens standard requires the employer to prepare a written

exposure control program. The standard requires the employer's plan to identify

workers performing routine tasks and procedures in the workplace that involve

exposure to blood or other potentially infectious materials, develop a schedule of how

and when the provisions of the standard will be implemented, and develop a plan of

action to betaken when an exposure incident occurs.

The schedule of how and when the provisions of the standard will be implemented may

be as simple as a calendar with brief notations describing the methods of compliance,

an annotated copy of the standard, or a part of another document, such as the exposure

control plan.

The plan must be reviewed, updated at least annually or whenever new tasks and

procedures affect occupational exposure; be made accessible to employees (in

accordance with Title 29 Code of Federal Regulations, Part 1910.20(e), Access to

Exposure and Medical Records); and be made available to the Assistant Secretary for

OSHA, and to the Director of the National institute for Occupational Safety and Health

(NIOSH) for examination and copying.

Planning begins with identifying employees who have occupational exposure.

Who Has Occupational Exposure?

The exposure determination must be based on the definition of occupational exposure

without regard to personal protective clothing and equipment. The exposure

determination is made by reviewing job classifications within the work environment,

and then making a list divided into two o groups. The first group includes job

classifications in which all of the employees have occupational exposure, such as

registered nurses, nurses aides, and laundry workers exposed to contaminated linen.

Where all employees have occupational exposure, it is not necessary to list specific

work tasks. The second group includes those classifications in which some of the

employees have occupational exposure. Where only some employees have exposure,

specific tasks and procedures causing exposure must be listed. An example of this type

of exposure could include a physical therapist working with a patient who has visible

open wounds.

Once occupationally exposed employees have been identified, the next step is to

communicate the hazards of the exposure to these employees.

4
Communicating Hazards to Employees

Each occupationally exposed employee must be given free information and training;

training must be provided during working hours.* The initial training for current

employees must be scheduled within 90 days of the effective date of the standard. New

employees must receive training at the time of their initial assignment. All employees

must receive annual training within 1 year of previous training and additional training

when existing tasks are modified or new tasks are assigned that involve occupational

exposure to bloodborne pathogens.

Training sessions must be comprehensive, including information on bloodborne

pathogens as well as on OSHA regulations and the employer's exposure control plan.

The person conducting the training must be knowledgeable in the subject matter as it

relates to long-term health care workers. The information provided must be written,

appropriate in content and vocabulary to the educational level, literacy, and language of

the audience, and contain the following elements

• How to access a copy of the regulatory text and an explanation of its contents;

• Information on the epidemiology and symptoms of bloodborne diseases;

• Ways in which bloodborne pathogens are transmitted;

• Explanation of the written exposure control plan and how to obtain a copy;

• Information on how to recognize tasks that might result in occupational

exposure;

• Explanation of the use and limitation of safe work practices, engineering

controls, and personal protective equipment;

• Information o n the types, selection, proper use, location, removal, handling,

decontamination and disposal of personal protective equipment;

*Employees who received training in the year preceding the effective date of the

standard need only receive training pertaining to any provisions of the standard that

were not included.

5
• information on hepatitis B vaccination such as safety, benefits, efficacy, methods

of administration and availability;

• Information on who to contact and what to do in an emergency;

• information on how to report an exposure incident and on the post-exposure

evaluation and followup;

• Information on warning labels, and color-coding.

Also, an opportunity for a question and answer period must be part of the session.

In addition to communicating hazards to employees and providing training to identify

and control hazards, other preventive measures also must be taken to ensure employee

protection.

Preventive Measures 

Preventive measures such as hepatitis B vaccination, Universal Precautions,

engineering controls, safe work practices, personal protective equipment, and

housekeeping measures help reduce the risks of occupational exposure.

Hepatitis B Vaccination

Hepatitis B vaccination must be made available after initial training and within 10

working days of initial assignment to every employee who has occupational exposure.

Following the appropriate training, hepatitis B vaccination must be made available

without cost to the employee, provided at a reasonable time and place, and performed

by or under the supervision of a licensed health care professional.*

The health care professional designated by the employer to implement this part of the

standard must be provided with a copy of the bloodborne pathogens standard. The

health care professional must provide written the employer with a written opinion

stating whether a hepatitis B vaccination is indicated for the employee or whether the

employee has received such vaccination.

Employers are not required to offer the hepatitis B vaccination if (1) the employee has

previously received the complete hepatitis B vaccination series. (2) antibody testing

*A person, such as a physician or nurse practitioner, whose legal scope of practice allows them

to perform the hepatitis B vaccination and post-exposure and followup required in the standard.

6
reveal that the employee is immune, or (3) medical reasons prevent the employee from

taking the vaccination. Employees may decline antibody testing and still be vaccinated.

Following appropriate training about hepatitis B and vaccination, employees who still

decline the vaccination must sign a statement to that effect (see Appendix A).

Employees who continue to be at occupational risk for hepatitis B may request and

obtain the vaccination at a later date. The hepatitis B vaccination series must be

administered according to the current guidelines of the U.S. Public Health Service,

including recommendations made in the future for routine booster doses. (For current

information on the U.S. Public Health Service's recommendations on hepatitis B

vaccination, long term health care workers may call the Centers for Disease Control:

DISEASE INFORMATION HOTLINE (404) 332-4555).

Universal Precautions

The single most important measure to control the transmission of HBV and HIV is to

treat all human blood and other potentially infectious materials as if they were

infectious for HIV and HBV. Application of this approach is referred to as "Universal

Precautions." Blood and other infectious materials from all long-term care patients

should be considered as potentially infectious materials. These fluids cause

contamination, defined in the standard as, "the presence or the reasonably anticipated

presence of blood or other potentially infectious materials on an item or surface."

Methods of Control

Engineering and Work Practice Controls

Engineering and work practice controls are the primary methods used to control the

transmission of HBV and HIV. Personal protective clothing and equipment also are

necessary when occupational

exposure to bloodhorne pathogens remains even after instituting these controls.

Engineering controls reduce employee exposure in the workplace by either removing

or isolating the hazard or isolating the worker from exposure. Suction apparatus,

self-sheathing needles, and special containers for contaminated sharp instruments are

examples of engineering controls.

7
Engineering controls must be examined and maintained, or replaced, on a scheduled

basis. Applicable engineering controls that apply to long-term health care workers

include, but are not limited to, the following:

• Use puncture-resistant, leak-proof containers to collect, handle, process, store,

transport, or ship blood specimens and potentially infectious materials. Label

these specimens if shipped outside the facility. Labeling is not required when all

specimens are handled using universal precautions and when specimens are

kept within the facility.

• Use puncture-resistant, leak-proof containers, color coded red or labeled

according to the standard (see Table 2) to discard contaminated items such as

sharps, broken glass, scalpels, or other items that could cause a cut or puncture

wound.

• Use puncture-resistant, leak-proof containers, color-coded red or labeled, to

store contaminated reusable sharps until they are properly reprocessed.

Engineering controls are to be used in combination with work practice controls.

Proper work practice controls reduce the likelihood of exposure by altering the

manner in which a task is performed. All procedures involving blood or other potentially

infectious materials must be performed in a manner that will minimize spattering,

splashing, spraying and the generation of droplets. Safe work practices include, but are

not limited to, the following:

• Do not eat, drink, smoke, apply cosmetics or lip balm, or handle contact lenses

in areas of occupational exposure;

• Do not mouth pipette or suction blood or other potentially infectious materials;

• Do not store food or drink in refrigerators or other locations where blood or

potentially infectious materials are kept;

• Wash hands when gloves are removed and as soon as possible after skin

contact with blood or other potentially infectious materials;

• Never recap, bend, or remove needles by hand unless the employer can

demonstrate that n o alternative is feasible or that such action is required by a

specific medical procedure. When recapping, bending, or removing

contaminated needles is required by a medical procedure, this must be done

8
Table 2. Labeling Requirements

Item

No Label Needed if

Universal precautions Are

Used and Specific Use of

Container or Item is

Known to All Employees

Biohazard

Label

Red

Container

Regulated waste container (e.g.,

contaminated sharps containers)

X or X

Reusable contaminated sharps

container (e.g., surgical

instruments soaking in a tray)

X or X

Refrigerator/freezer holding

blood or other potentially

infectious material

X

Containers used for storage,

transport or shipping of blood

X or X

Blood/blood products for

clinical use

No labels required

Individual specimen containers

of blood or other potentially

infectious materials remaining

in facility

X or X or X

Contaminated equipment X

needing service (e.g., dialysis

equipment; suction apparatus) plus a label specifying

where the contamination exists

Specimens and regulated waste

shipped from the primary

facility to another facility for

service or disposal

X or X

Contaminated laundry or X or X

Contaminated laundry sent to

another facility that does not

use Universal Precautions

X or X

*Alternative labeling or color coding is sufficient if it permits all employees to recognize the

containers as requiring compliance with Universal Precautions.

9
 by mechanical means, such as the use of forceps or

a one handed technique.

• Never shear or break contaminated needles.

• Discard contaminated needles and sharps instruments in containers that are

closable, puncture-resistant, leakproof, colored red or labeled with the biohazard

symbol* (see Figure 1); ensure that containers are accessible, maintained

upright, and not allowed to overfill.

Figure 1. Biohazard Symbol

Personal Protective Equipment

In addition to instituting engineering and work practice controls, the standard requires

that personal protective equipment also be, used to reduce worker risk of exposure.

The use of personal protective equipment helps prevent occupational exposure to

infectious materials. Such equipment includes, but is not limited to, gloves, gowns, and

laboratory coats. Personal protective equipment is considered appropriate only if it

does not permit it blood or other potentially infectious materials pass through or to reach

employees’ work clothes, street clothes, undergarments, skin, eyes, mouth, or other

mucous membranes under normal conditions of use and for the duration of time the

protective equipment will be used.

Under the standard, employers must provide, make accessible, and require the use of

personal protective equipment at no cost to the employee. Personal protective

*Label requires a fluorescent orange or orange-red label with the biological hazard

symbol, along with the word "BIOHAZARD" in a contrasting color, affixed to the bag or

container.

10
equipment also must be provided in appropriate sizes. Hypoallergenic gloves,

cotton liners, or other similar alternatives must be made available to 

employees who have an allergy or sensitivity to gloves. Employers also

must ensure that protective equipment is properly cleaned, laundered, repaired or

replaced, as needed, or discarded.

An employee may temporarily and briefly decline wearing personal protective

equipment under rare and extraordinary circumstances and when, in the employee's

professional judgement, it prevents the delivery of health care or public safety services

or poses an increased hazard to employees. These circumstances would be expected

to be life threatening. An example might be a sudden change in patient status when an

apparently stable patient unexpectedly begins to hemorrhage profusely--placing the

patient's life in immediate jeopardy. In general, appropriate personal protective

equipment is expected to be used whenever occupational exposure may occur.

The employer also must ensure that employees observe the following precautions for

safely handling and using personal protective equipment:

• Remove protective equipment before leaving the work area and after a garment

becomes contaminated.

• Place used protective equipment in appropriately designated areas or containers

when being stored, washed, decontaminated, or discarded.

• Wear appropriate gloves when it can be reasonably anticipated that the

employee may experience contact with blood and other potentially infectious

materials; when performing vascular access procedures, and when handling or

touching contaminated hems or surfaces. Replace gloves if torn, punctured,

contaminated, or their barrier function is compromised.

• Never wash or decontaminate disposable gloves for reuse.

• Discard utility gloves when they show signs of cracking, peeling, tearing,

puncturing, or deteriorating. Utility gloves may be decontaminated for reuse if

their integrity is not compromised.

In places where there are no hand washing facilities, workers must be provided with

either appropriate antiseptic hand cleaner in conjunction with clean cloth/paper towels,

or antiseptic towelettes. When antiseptic hand cleansers or towelettes are used,

11
hands should be washed with soap and running water as soon as feasible.

Housekeeping 

Under the standard, each place of employment must be kept clean and sanitary. To do

this, the employer must develop and implement a cleaning schedule that includes

appropriate methods of decontamination and tasks or procedures to be performed. This

written schedule must be based on the location within the facility, the type of surfaces to

be cleaned, the type of contamination present, the tasks or procedures to be performed,

and their location within the facility.

Equipment. Contaminated equipment and environmental and work surfaces must be

cleaned and decontaminated, Contaminated work surfaces must be decontaminated

with an appropriate disinfectant upon completion of procedures, immediately when

overtly contaminated, after any spill of blood or other potentially infectious materials,

and at the end of the work shift when surfaces have

become contaminated since the last cleaning. Surfaces and equipment protected with

materials such as plastic wrap or aluminum foil, must be inspected frequently for

contamination; and these protective coverings must be changed when found to be

contaminated, or at the end of the work shift.

Reusable receptacles such as bins, palls, and calls must be inspected and

decontaminated o n a regularly scheduled basis. Broken glass must be cleaned up with

a brush and a dust pan or tongs; never pick up broken glass with hands, even when

wearing gloves.

Waste. Waste removed from the facility is regulated by federal, state, and local laws.

To comply with the bloodborne pathogens standard, special precautions are necessary

when discarding contaminated sharps and other regulated waste, and include the

following:

• Put regulated waste' in containers that are closeable, leakproof, puncture

resistant, and appropriately labeled (see Table 2).

*Liquid or semiliquid blood or other potentially infectious materials; items contaminated with

blood or other potentially infectious materials that would release these substances in a liquid or

semi-liquid state if compressed; items 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.

12
• When discarding contaminated, disposable sharps and other regulated waste

place them in closable, puncture-resistant, leak-proof, appropriately labeled red

color-coded containers.

• Dispose of all regulated waste according to federal, state, and local regulations.

Laundry. Laundering contaminated articles, including employee lab coats and uniforms

that are used to protect the employee from occupational exposures, is the responsibility

of the employer. This can be accomplished through the use of a washer and dryer on

site, or the contaminated articles can be sent to a commercial laundry that processes

contaminated laundry. The following requirements should be met with respect to

contaminated laundry:

• Handle contaminated laundry as little as possible and with a minimum of

agitation.

• Wear gloves or other appropriate personal protective equipment when handling

contaminated laundry.

• Never sort or rinse contaminated laundry in areas of its use.

• Bag contaminated laundry at its location of use.

• If contaminated laundry is sent off-site for cleaning, place it in bags or containers

that are clearly marked with the biohazard symbol, unless the laundry utilizes

"Universal Precautions" in the handling of all soiled laundry.*

• Place wet contaminated laundry in leak-proof, labeled or color coded containers

before transporting.

As already indicated, the above preventive measures are intended to eliminate or

minimize the risks of occupational exposure. In the event exposure occurs, however,

certain procedures are required.

*Alternative labeling or color coding is sufficient if it permits all employees to recognize the

containers as requiring compliance with Universal Precautions (1910.1030(d)(4)(iii)(B)(iv)(A)(2)).

13
What to Do if an Exposure Incident Occurs

An exposure incident is a specific eye, mouth, membrane, non-intact skin, or parenteral

contact with blood or other potentially infectious materials that results from the

performance of an employee's duties. An example of an exposure incident would

include a puncture from a contaminated sharp or other instrument. The employer is

responsible for establishing the procedure for evaluating exposure incidents.

When evaluating an exposure incident, immediate assessment and confidentiality are

critical issues. Employees should immediately report exposure incidents to enable

timely medical evaluation and followup by a health care professional as well as to make

a prompt request for testing of the source individual's blood for HIV and HBV.

All evaluations and followup must be made available immediately for employees who

experience an exposure incident. All evaluations and followup must be made available

at no cost to the employee and at a reasonable time and place, performed by or under

the supervision of a licensed physician or another appropriately licensed health care

professional, such as a nurse practitioner, and according to current recommendations of

the U.S. Public Health Service guidelines current at the time of the evaluation and

procedure. In addition, all laboratory tests must be conducted by an accredited

laboratory and at no cost to the employee.

At the time of an exposure incident, exposed employee must be directed to a health

care professional. The employer must provide the health care professional with a copy

of OSHA's bloodborne pathogens standard; a description of the employee's Job duties

relevant to the exposure incident; documentation about the specific exposure,

circumstances of exposure and results of the source individual's blood tests, if available;

and all relevant employee medical records, including vaccination status. At that time,

the health care professional must collect the exposed employee's blood and test it for

HBV and HIV serological status. If the employee does not give consent for HIV

serological testing for baseline testing, the employee's blood sample must be kept for at

least 90 days.*

The "source individual" is any patient whose blood or body fluids are the source of an

exposure incident to the employee.

*If during this time, the employee elects to have the baseline sample tested, testing

shall be performed as soon as feasible.

14
Testing the source individual's blood does not need to be repeated if the source

individual is known to be infectious for HIV or HBV.* The results of the source

individual's blood tests are confidential. As soon as possible, however, the test results of

the source individual's blood must be made available to the exposed employee as well

as information about applicable disclosure laws and regulations concerning the source

identity and infectious status.

Following post-exposure evaluation, the health care professional will provide a written

opinion to the employer. This opinion is limited to a statement that the employee has

been informed of the results of the medical evaluation and any medical conditions

resulting from the exposure incident that may require further treatment. All other findings

are confidential and must not be included in the written report. The employer must

provide a copy of the written opinion to the employee within 15 days of the completion

of the evaluation.

Recordkeeping

There are two types of records required by the bioodborne pathogens standard: medical

and training.

A medical record must be preserved and maintained for each employee with

occupational exposure. This record is confidential and separate from other personnel

records. This record may be kept onsite or may be retained by the health care

professional who provides services to employees. The medical record must contain the

employee's name and social security number, hepatitis B vaccination status including

the dates of vaccination and medical records related to the employee's ability to receive

vaccinations, results of examination, medical testing, and post-exposure evaluation and

followup procedures, and the health care professional's written opinion regarding the

vaccination. The medical record also must document what information has been

provided to the health care provider.

If an exposure incident occurs, reports are added to the medical record to document the

incident the results of testing following the incident, and the written opinion of the health

care professional.

Medical records must be maintained for at least the duration of employment plus 30

years.

*Testing cannot be done in most states without written consent. lf consent is not obtained, the

employer must show that legally required consent could not be obtained. Where consent is not

required by law, the source individual's blood, if available, should be tested and the results

documented.

15
Training records document each training session and are to be kept for 3 years.

Training records must include the dates, content of the training, trainer's name and

qualifications, and names and job titles of all persons attending the training sessions.

If the employer ceases to do business, medical and training records must be transferred

to the successor employer. If there is no successor employer, the employer must notify

the Director of the National Institute for Occupational Safety and Health (NIOSH), for

specific directions regarding of the records at least 3 months prior to intended disposal.

Upon request, both medical and training records must be made available to the Director

of NIOSH and to the Assistant Secretary of Labor for Occupational Safety and Health. If

the employer ceases to do business, medical and training must be made available to

the Director of NIOSH and to the Assistant Secretary of Labor for Occupational Safety

and Health. Training records must be made available to employees or employee

representatives upon request. An employee’s medical records can only be obtained by

the employee or anyone having the employee’s written consent. (For further

information about employee access to medical and exposure records, see Title 29 Code

of Federal Regulations 1910.10(3) Access to Employee Exposure and Medical

Records). Additional recordkeeping is required for employers with 11 or more

employees (see Title 29 Code of Federal Regulations 1904 Recordkeeping Guidelines

for Occupational Injuries and Illnesses).

Other Sources of Assistance

Consultation Programs

Consultation assistance is available to employers who want help in establishing and

maintaining a safe and healthful workplace. Largely funded by OSHA, the service is

provided at no cost to the employer. Primarily developed for smaller employers with

more hazardous operations, the consultation service is delivered by state government

agencies or universities employing professional safety consultants and health

consultants. Comprehensive assistance includes an appraisal of all mechanical,

physical work practice, and environmental hazards of the workplace and all aspects of

the employer's present job safety and health program. No penalties are proposed or

citations issued for hazards identified by the consultant.

For more information concerning consultation assistance, see the list of consultation

projects listed at the end of this publication (Appendix B).

16
Voluntary Protection Programs

Voluntary protection programs (VPP) and on-site consultation services, when coupled

with an effective enforcement program, expand worker protection to help meet the goals

of the Occupational Safety and Health Act. The three VPPs – Star, Merit, and

Demonstration – are designed to recognize outstanding achievement by companies that

have successfully incorporated comprehensive safety and health programs into their

total management system. They motivate others to achieve excellent safety and health

results in the same outstanding way and they establish a cooperative relationship

among employees, and OSHA.

For additional information on VPPs and how to apply, contact the OSHA national,

regional, or area offices listed at the end of this publication (Appendix B).

Training and Education

OSHA's area offices offer a variety of informational services, such as publications,

audiovisual aids, technical advice, and speakers for special engagements. Each

regional office has a bloodborne pathogens coordinator to assist employers.

OSHA's Training Institute in Des Plaines, IL, provides basic and advanced courses in

safety and health for federal and state compliance officers, state consultants, federal

agency personnel, and private sector employers, employees, and their representatives.

OSHA also provides funds to nonprofit organizations. through grants, to conduct

workplace training and education in subjects where OSHA believes there is a lack of

workplace training. Current grant subjects include agricultural safety and health, hazard

communication programs, and HIVand HRV Grants are awarded annually, with a

1-year renewal possible. Grant recipients are expected to contribute 20 percent of the

total grant cost.

For more information on grants, and training and education, contact the OSHA Training

Institute, Office of Training and Education, 1555 Times Drive, Des Plaines, IL 60018,

(708) 297-4810.

17
Appendix A

The following statement of declination of hepatitis B vaccination must be

signed by an employee who chooses not to accept the vaccine. The

statement can only be signed by the employee following appropriate

training regarding hepatitis B, hepatitis B vaccination, the efficacy, safety,

method of administration, and benefits of vaccination, and that the vaccine

and vaccination are provided free of charge to the employee. The

statement is not a waiver; employees can request and receive the

hepatitis B vaccination at a later date if they remain occupationally at risk

for hepatitis B.

18

Declination Statement

l understand that due to my occupational exposure to blood or other

potentially infectious materials I may be at risk of acquiring hepatitis B

virus (HBV) infection. l have been given the opportunity to be vaccinated

with hepatitis B vaccine, at no charge to myself. However, l decline

hepatitis B vaccination at this time. I understand that by declining this

vaccine I continue to be at risk of acquiring hepatitis B, a serious disease.

if in the future l continue to have occupational exposure to blood or other

potentially infectious materials and l want to be vaccinated with hepatitis

B vaccine, I can receive vaccination series at no charge to me.

Employee Signature Date
Appendix B

OSHA Consultation Project Directory

Consultation programs provide free services to employers who request help in

identifying and correcting specific hazards, want to improve their safety and health

programs, and/or need further assistance in training and education. Funded by OSHA

and delivered by well-trained professional staff of state governments, consultation

services are comprehensive, and include an appraisal of all workplace hazards,

practices, and job safety and health programs; conferences and agreements with

management; assistance in implementing recommendations; and a followup appraisal

to ensure that any required corrections are made. For more information on consultation

programs, contact the appropriate office in your state listed below

State......................................................Telephone

Alabama ...............................................(205) 348-3033

Alaska ..................................................(907) 264-2599

Arizona ................................................(602) 255-5795

Arkansas ..............................................(501) 682-4522

California .............................................(415) 737-2843

Colorado ..............................................(303) 491-6151

Connecticut ..........................................(203) 566-4550

Delaware ..............................................(302) 577-3908

District of Columbia .............................(202) 576-6339

Florida ..................................................(904) 488-3044

Georgia ................................................(404) 894-8274

Guam ....................................................(671) 646-9244

Hawaii ..................................................(808) 548-4155

Idaho ....................................................(208) 385-3283

Illinois ..................................................(312) 814-2339

Indiana .................................................(317) 232-2688

Iowa .....................................................(515) 281-5352

Kansas ..................................................(913) 296-4386

Kentucky...............................................(502) 564-6895

Louisiana ..............................................(504) 342-9601

Maine ...................................................(207) 289-6460

Maryland ..............................................(301) 333-4218

Massachusetts ......................................(617) 727-3463

Michigan ..............................................(517) 335-8250 (H)

.........................................................(517) 322-1809 (S)

Minnesota ............................................(612) 297-2393

19
Mississippi ...........................................(601) 987-3981

Missouri ...............................................(314) 751-3403

Montana ...............................................(406) 444-6401

Nebraska ..............................................(402) 471-4717

Nevada .................................................(702) 688-1474

New Hampshire ...................................(603) 271-3170

New Jersey ...........................................(609) 292-0404

New Mexico .........................................(505) 827-2885

New York .............................................(518) 457-2481

North Carolina .....................................(919) 733-3949

North Dakota .......................................(701) 221-5188

Ohio .....................................................(614) 644-2631

Oklahoma .............................................(405) 528-1500

Oregon .................................................(503) 378-3272

Pennsylvania ........................................(412) 357-2561

Puerto Rico ..........................................(809) 754-2171

Rhode Island ........................................(401) 277-2438

South Carolina .....................................(803) 734-9599

South Dakota .......................................(605) 688-4101

Tennessee .............................................(615) 741-7036

Texas ....................................................(512) 440-3834

Utah ......................................................(801) 530-6868

Vermont ...............................................(802) 828-2765

Virginia ................................................(804) 786-6613

Virgin Islands ......................................(809) 772-1315

Washington ..........................................(206) 586-0963

West Virginia .......................................(304) 348-7890

Wisconsin ............................................(608) 266-8579 (H)

.........................................................(414) 521-5063 (S)

Wyoming .............................................(307) 777-7786

H—Health S—Safety

20
States with Approved Plans

States administering their own occupational safety and health programs through plans approved under

section 18(b) of the Occupational Safety and Health Act of 1970 must adopt standards and enforce

requirements that are at least as effective as federal requirements.

There are currently 25 state plan states: 23 cover the private and public (state and local government)

sectors and 2 cover the public sector only.

Commissioner

Alaska Department of Labor

P.O. Box 21149

Juneau AK 99801

(907) 465-2700

Director

Industrial Commission of Arizona

800 W. Washington

Phoenix, AZ 85007

(602) 542-5795

Director

California Department

of Industrial Relations

455 Golden Gate Avenue

4th Floor

S. San Francisco, CA 94102

(415) 703-4590

Commissioner

Connecticut Department of Labor

200 Folly Brook Boulevard

Wethersfield, CT 06109

(203) 566-5123

Director

Hawaii Department of Labor and

Industrial Relations

830 Punchbowl Street

Honolulu, HI 96813

(808) 586-8844

Commissioner

Indiana Department of Labor

1013 State Office Building

100 North Senate Avenue

Indianapolis, IN 46204-2287

(307) 232-2665

Commissioner

Iowa Division of Labor Services

1000 E. Grand Avenue

Des Moines, IA 50319

(515) 281-3447

Acting Commissioner

for Workplace Standards

Kentucky Labor Cabinet

1049 U.S. Highway, 127 South

Frankfort, KY 40601

(502) 564-3070

Commissioner

Maryland Division of Labor

and industry

Department of Licensing

and Regulation

501 St. Paul Place, 2nd Floor

Baltimore, MD 21202-2272

(301) 333-4179

Director

Michigan Department of Labor

Victor Office Center

201 N. Washington Square

P.O. Box 30015

Lansing, MI 48933

(517) 373-9600

21
Director

Michigan Department

of Public Health

3423 North Logan Street

Box 30195

Lansing, MI 48909

(517) 335-8022

Commissioner

Minnesota Department

of Labor and industry

443 Lafayette Road

St. Paul, MN 55155

(612) 296-2342

Director

Division of industrial

Relations

400 West King Street

Carson City, NV 89710

(702) 687-3032

Secretary

New Mexico Environmental

Department

Occupational Health

and Safety Bureau

1190 St. Francis Drive

P.O. Box 26110

Santa Fe, NM 87502

(505) 827-7850

Commissioner

New York Department

of Labor

State Office Building –

Campus 12

Room 457

Albany, NY 12240

(518) 457-2741

Commissioner

North Carolina

Department of Labor

319 Chapanoke Road

Raleigh, NC 27603

(919) 662-4585

Administrator

Oregon Occupational Safety

and Health Division

Department of Consumer

and Business Services,

Room 430

Labor and Industries Building

350 Winter Street, NE

Salem, OR 97310

(503) 378-272

Secretary

Puerto Rico Department

of Labor and Human Resources

Prudencio Rivera Martinez.

Building

505 Munoz Rivera A-venue

Hato Rey, PR 00918

(809) 754-2119

Commissioner

South Carolina Department

of Labor

3600 Forest Drive

P.O. Box 11329

Columbia, SC 29211-1329

(803) 734-9594

22
Commissioner

Tennessee Department of Labor

501 Union Building

Suite “A”- 2nd Floor

Nashville, TN 37243-0655

(517) 741-2582

Administrator

Utah Occupational

Safety and Health

160 East 300 South, 3rd Floor

P.O. Box 5800

Salt Lake City, UT 84114-6600

(801) 530-6900

Commissioner

Vermont Department of

Labor and Industry

120 State Street

Montpelier, VT 05620

(802) 828-2788

Commissioner

Virgin Islands

Department of Labor

2131 Hospital Street,

Box 890

Christiansted

St. Croix, VI 00840-4666

(809) 773-1994

Commissioner

Virginia Department of

Labor and Industry

Powers-Taylor Building

13 South 13th Street

Richmond, VA 23219

(804) 786-9873

Director

Washington Department of

Labor and Industries

General Administration Building

Room 334-AX-31

Olympia, WA 98504-0631

(206) 753-6307

Director

Department of Employment

Division of Employment Affairs

Occupational Safety and

Health Administration

Herschler Building, 2nd Floor East

122 West 25th Street

Cheyenne, WY 82002

(307) 777-7786 or 777-7787

23
Related Publications

A single free copy of the following materials may be obtained from OSHA field

offices or the OSHA Publications Office, 200 Constitution Avenue, N.W., Room N3101, Washington, DC 20210, (202) 523-9667. Send a self-addressed label with your

written request.

Access to Medical and Exposure Records—OSHA 3110

All About OSHA—OSHA 2056

Bloodborne Pathogens and Acute Health Care Workers—OSHA 3128

Bloodborne Pathogens and Dental Workers—OSHA 3129

Bloodborne Pathogens and Emergency Responders—OSHA 3130

Bloodborne Pathogens and Long-Term Care Workers—OSHA 3131

Chemical Hazard Communication—OSHA 3084

Consultation Services for Workplace Emergencies—OSHA 3047

Employee Workplace Rights—OSHA 3021

How to Prepare for Workplace Emergencies—OSHA 3000

Occupational Exposure to Bloodborne Pathogens—OSHA 3127

Personal Protective Equipment—OSHA 3077

Also, copies of the following OSHA materials may be obtained from the U.S.

Government Printing Office (GPO), Washington, DC 20402, (202) 783-3238

When ordering publications from the Government Printing Office, include GPO order

numbers and make checks payable to the Superintendent of Documents. GPO gives a

25-percent discount for orders of 100 or more copies. Credit card charge (MasterCard

and Visa) is accepted.

24
All prices subject to change by GPO.

Chemical Hazard Communication Guidelines (OSHA 3111)

Order No. 029-16-00127-1. Cost: $1.00

Ergonomics: The Study of Work (OSHA 3125)

Order No. 029-016-00124-7. Cost: $1.00

Occupational Exposure to Bloodborne Pathogens,

Federal Register 56 (235): 64004-64182, December 6, 1991

Order No. 069-001-00040-8. Cost: $2.00

25
U.S. Department of Labor

Occupational Safety and Health Administration

Regional Offices

Region I

(CT,* MA, ME, NH, RI, VT*)

133 Portland Street

1st Floor

Boston, MA 02114

Telephone: (617) 565-7164

Region II

(NJ, NY, * PR,* VI*)

201Varick Street

Room 670

New York, 10014

Telephone: (212) 337-2378

Region III

(DC, DE,MD,* PA, VA,* WV)

Gateway Building, Suite 2100

3535 Market Street

Philadelphia, PA 19104

Telephone:(215) 596-1201

Region IV

(AL, FL, GA, KY,* MS, NC,*

SC,* TN*)

1375 Peachtree Street, N.E.

Suite 587

Atlanta, GA 30367

Telephone: (404) 347-3573

Region V

(IL, IN,* MI,* MN,* OH, WI)

230 South Dearborn Street

Room 3244

Chicago, IL 60604

Telephone: (312) 353-2220

Region VI

(AR, LA, NM,*OK, TX)

525 Griffin Street

Room 602

Dallas, TX 75202

Telephone: (214) 767-4731

Region VII

(IA,* KS, MO, NE)

911 Walnut Street, Room 406

Kansas City, MO 64105

Telephone: (816) 426-5861

Region VIII

(CO, MT, ND, SD, UT,* WY*)

Federal Building, Room 1576

1961 Stout Street

Denver, CO 80294

Telephone: (303) 844-3061

Region IX

American Samoa, AZ,* CA,*

Guam, HI,* NV,* Trust

Territories of the Pacific)

71 Stevenson Street,

Room 415

San Francisco, CA 94105

Atlanta, GA 30367

Telephone: (415) 744-6670

Region X

(AK,* ID, OR,* WA*)

1111 Third Avenue

Suite 715

Seattle, WA 98101-3212

Telephone: (206) 553-5930

* These states and territories operate their own OSHA-approved job safety and health programs

(Connecticut and New York plans cover public employees only). States with approved programs

must have a standard that is identical to, or at least as effective as the federal standard.