An editable Bloodborne Pathogens Exposure Control Plan template for non-medical home care agencies.

For owners and administrators who need a written plan for staff whose tasks may involve contact with blood or other body fluids.

What’s included (18 pages; editable Word .docx):

• Pages 1-11: cover page, contents page and 13 sections: Purpose and policy; Plan administration; Access to this plan; Exposure determination; Methods of compliance (standard precautions, work practices, PPE, housekeeping in the client’s home); Hepatitis B vaccination; After an exposure incident; Reviewing each incident; Labels and training; Recordkeeping; Annual review and employee input; State-varies note; Responsibility and related forms
• Appendix 1: exposure determination worksheet
• Appendix 2: hepatitis B vaccine offer and record
• Appendix 3: hepatitis B vaccine declination
• Appendix 4: exposure incident follow-up checklist
• Appendix 5: sharps injury log (only if your agency must keep injury and illness records)
• Appendix 6: annual review and front-line employee input
• Page 18: Agency Instructions page (remove before use)

How to customize:

1. Open the Word file and use Home > Replace > Replace All to change [Agency Name] to your agency’s name.
2. Replace [City] and [State] in the letterhead the same way; [Agency Name] also sits in the gray page header from page 2 on, so check it there.
3. Fill each [State] spot and the job classifications, names and record locations; read the plan against the current federal standard before you adopt it.
4. Add your logo to the letterhead if you want one (there is no logo box), then delete the final Agency Instructions page before use.

Some lines cross-reference policy numbers from a companion Policy & Procedure Manual (sold separately); edit them to match your own policies.

Customizable template, not legal advice; check your state’s requirements. Not a license to operate, not HIPAA software, and no medical claims. It is not a clinical protocol, it is not a certification, and it does not promise that you meet any law or standard; review it against current public health guidance and your state’s rules before use.