Sample Baseline Assessment Worksheet for Sharps Injury Prevention Program

As part of a facility's efforts to develop an effective sharps injury prevention program, it is valuable to perform a baseline assessment of current activities and processes.


Included in the Centers for Disease Control and Prevention's "Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program" is a sample worksheet for performing such an assessment.


The CDC provides questions related to several program areas as a guide for performing this assessment. The worksheet has organizations identify their current practices and then outline strategies for improvement.


Once completed, the worksheet can be used as a springboard for discussing program improvements that will help lead to a reduction in sharps injuries in healthcare personnel. Healthcare organizations should adapt the worksheet as necessary to meet their program needs.


To download this CDC-developed baseline sharps injury prevention program assessment worksheet for adaptation and use in your facility, click here (pdf).


Download other patient safety-related tools and resources:


- Sample Surgical Wound Classification Form


- Sample Hand Hygiene Observation Record


- Sample MRSA Policy

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