BPPA Exposure Form
Form is to collect information on members of the BPPA who have been exposed to hazardous conditions
Email address *
Date *
MM
/
DD
/
YYYY
Area / District
Your answer
Incident Number *
Your answer
Incident Location *
Your answer
Incident Type *
Your answer
Officer's Name
Your answer
Officer's ID#
Your answer
Assigned District / Unit
Your answer
Nature of Exposure
Source Of Exposure
What Precautions Did You Take?
Was A Report Submitted?
What Type Of Report?
What Type Of Treatment Did You Perform/ Receive?
Did You Go Out Injured?
Narrative
Your answer
A copy of your responses will be emailed to the address you provided.
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