Part 3, Chapter 27: Manual Exhibit 3-27-G

I understand that health care workers who handle hazardous drugs may experience negative effects such as skin rashes, adverse reproductive events, and an increased risk for cancer.

I understand that it is important that I read, understand, and have access to both local and national policy on handling hazardous drugs. National policy may be found within part 3, chapter 27 of the Indian Health Manual (IHM) https://www.ihs.gov/ihm/pc/part-3/p3c27/. I understand that local policy and procedures will be reviewed by leadership annually and that updates will occur as needed based on local policy requirements, federal regulatory requirements, and changing practice standards as identified by professional associations.

I certify that I have been trained on the local and national policies and procedures of hazardous drugs and completed the required local competency requirements. I understand that I will be required to complete local competency requirements on an annual basis.

I understand and acknowledge that it is the responsibility of all employees who handle hazardous drugs, male and female, to inform their immediate supervisor if they have any medical reasons to avoid exposure, such as trying to conceive, when they become pregnant, or when lactating.

I acknowledge that my facility has put into place a variety of administrative, engineering, and work controls designed to reduce my risk of occupational exposure to hazardous drugs and that failure to follow established policies and procedures could lead to increased risk of skin rashes, adverse reproductive events such as infertility, miscarriage, or birth defects; and the development of cancer.

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Name of Employee                                                          Date

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Signature