There are two versions of the reporting form:

1. Two-page form with drop down menus in the response fields
   • This version lets you save the form and use fillable data entry
2. Three-page form for printing and hand-written completion

Please only send us one of these forms. Do not send both forms.  

How to Use the Reporting Forms 

The facility where the injury happened should report it. That facility will complete the form and send it to its local health authority. The facility can send their form to one of our regional directors if there isn't a local health authority.  

The local health authority reviews the report and then forwards it to our Healthcare Safety Unit:  Fax 512-776-7616 or Sharps.injury@dshs.texas.gov. 

You can get a copy of the contaminated sharps injury reporting form on one of the links below or from one of our public health regional offices.

• Get a copy of the two-page fillable form (PDF)
• Get a copy of the three-page manual form (PDF)

We’ve also compiled a list of related sites for infectious disease control. These will help you get more information about contaminated sharps safety. 

• Learn more about bloodborne pathogens
• Review annual reports for contaminated sharps injury data
• Visit the healthcare safety unit’s site
• Regional Local Health Operations - Public Health Regions