EMS Exposure Reporting Fields marked with an * are required. Incident Number Location Date of Exposure Reported To Hospital Hospital Patient Name Patient Tested Patient Carrier Details Protective Measures EMS Jacket Face Shield Gloves Worn Gown Worn Turn-Out Pants used Other How Exposure Occured Airborne Pathogens Contact w/Mucus Membrane Contact w/open, non-intact skin Cut while cleaning equipment Laceration Needle Stick Other Fire Send Message California State Firefighters' Association 440 N Barranca Ave #6164 Covina, CA 91723 (800) 451-2732 membership@csfa.net Powered By GrowthZone