Basic Phlebotomy /
Advanced Competency Practical /
Cannulation Training Consent Form

1. Purpose

During training, I will be involved in learning and practising blood drawing techniques using manikin arms. I will be given opportunities to attend the live blood draw sessions, and I will draw blood samples from my fellow students while being closely supervised by the trainer. I give my consent to fully cooperate with the trainer and follow the procedures. Specifically, I agree not to un-sheath any sharps without the trainer being present to give permission for the procedure to continue.

If I do not follow the procedures correctly, there could be a risk of needle-stick injury. This agreement outlines the procedures, responsibilities, and actions to be taken in the event of a needlestick injury to ensure compliance with workplace/training safety regulations, minimise risk, and provide appropriate medical care and follow-up.

2. Responsibilities

Lead Academy agrees to:

• Provide training on safe needle handling practices.
• Supply necessary personal protective equipment (PPE).
• Maintain a comprehensive Needlestick Injury Prevention Plan.

The Learner involved agrees to:

• Adhere to the organisation’s safety policies and procedures.
• Use PPE and proper techniques when handling sharps.
• Immediately report any needlestick injuries to a Supervisor/Trainer.
• Participate in follow-up procedures, including medical evaluations in A&E.

3. Incident Reporting

Immediate Action:

Wash the affected area thoroughly with soap and running water for a minimum of 10-20 minutes. Notify the supervisor immediately. Dispose of the needle safely.

Reporting:

Complete an incident report form detailing the circumstances of the injury. Submit the report of the incident immediately to the Trainer/Supervisor.

Follow-Up:

• Arrange for medical evaluation and testing in A&E as soon as possible.
• Review the incident for corrective actions to prevent future occurrences.

4. Confidentiality

All medical information and records related to a needlestick injury shall be kept confidential and handled in compliance with applicable privacy laws.

5. Compensation and Costs

Lead Academy will not be liable to cover the costs of any medical care, necessary tests, and treatments following the injury.

6. Learner’s Acknowledgment

By signing this Agreement, I acknowledge:

• Awareness of the risks associated with handling sharps.
• Understanding of the reporting and follow-up process.
• Commitment to adhering to safety protocols.