TDICT Scalpels blades evaluation form

Download the Scalpels and Blades with Sharps Injury Prevention (SIP) Features Evaluation Form as a PDF
Date
Date Format: MM slash DD slash YYYY
Department
Occupation
Product
Number of times used
This evaluation form should be completed by frontline non-managerial employees who are responsible for direct patient care, cleaning/disinfecting/sterilizing surfaces or devices, and laboratory personnel or anyone at risk of experiencing a sharps injury. The completion of this evaluation and review is designed to assist employers with the requirements set forth in the OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030 (c)(1)(v)).
Please circle the most appropriate answer for each question. Not applicable (N/A) may be used if the question does not apply to this specific product. Regarding functionality, it is assumed that the blade is sharp enough for intended use and patient outcomes are maintained or improved with the use of this device. It is also assumed that the device can be used with wet gloves and does not interfere with the procedure.
General Considerations for the Evaluation of Scalpels and Blades with SIP Features:

During Use:

	Strongly agree	Agree	Neutral	Disagree	Strongly disagree	NA
1. The scalpel protects users and non-users (e.g., during passing or placement on neutral zone).
2. The device can easily be operated with one hand.
3. The device is ambidextrous.
4. The SIP feature/mechanism is obvious.
5. The SIP feature can be activated without repositioning grip.
6. The SIP feature can be activated without repositioning grip.
7. It is obvious when the device is not protected.
8. The device is color coded and/or labeled to indicate blade type. 1
9. The device makes an audible sound when the SIP feature is abled and/or disabled.
10. The device does not require existing procedures be significantly altered or changed,
11. The product works well with a variety of hand sizes.
12. If retracting blade, the blade fully retracts into the housing of the device – or - if shielded blade, the shield completely covers the blade
13. All (or most) conventional scalpel/blade sizes are available.
14. The product is suitable for a variety of types of procedures.

After Use & During Disposal or Reprocessing:

	Strongly agree	Agree	Neutral	Disagree	Strongly disagree	NA
15. If disposable, the product can easily be placed in a sharps container
16. If reusable, the scalpel blade can be removed without using the hands
17. If the handle is reusable, the product can be safely and adequately cleaned and disinfected (reprocessed) without compromising its integrity.
18. Once activated, the safety feature stays active until disposal.
19. Product manufacturers have provided clear instructions for use, storage, disposal and/or reprocessing.

Of the above questions, which three are most important to your safety when using this product/device?
Are there other questions that you feel should be asked or addressed regarding the safety and utility of this product/device?
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