Please put a tick in the appropriate brackets.

1.a) Where did you go for your elective?

b) Was the area rural ( ) or urban ( ) or both ( )?

2. What did you do?

3.a) Have you received a full course of hepatitis B vaccine? yes ( ) no ( )

b) Did you have a blood test to measure your antibody response to the vaccine? yes ( ) no ( )

c) How well did you respond? adequately ( ) inadequately ( ) (<100mIU/ml) ( ) not at all ( ) don't know ( )

d) Do you have documented evidence of your response? yes ( ) no ( )

e) Have you had a booster dose? yes ( ) no ( )

4.Did you discuss your elective with: your clinical adviser? yes ( ) no ( )

occupational Health? yes ( ) no ( )

5. Was the HIV seroprevalence relatively high where you did your elective? yes ( ) no ( ) don't know( )

6. Did you discuss the risk of infection with blood-borne viruses on your elective with your clinical adviser?

yes ( ) no ( )

7. Did you take a course of zidovudine with you on your elective? yes ( ) no ( )

8. Did you take a medi-kit with you? yes ( ) no ( )

9. Did you take latex gloves with you? yes ( ) no ( )

10. Did you have a dental check-up prior to your elective? yes ( ) no ( )

11. How many exposures, either percutaneous ( eg. needle-stick injury / contamination of a fresh cut )

or mucosal with blood or other body fluids did you have on your elective?

none ( ) 1-5 ( ) >5 ( )

12. If you were exposed,

a) did you apply immediate first aid? yes ( ) no ( ) sometimes ( )

b) did you report the incident/ incidents immediately? yes ( ) no ( ) sometimes ( )

c) did you know the HIV status of the patient/patients involved? yes ( ) no ( ) sometimes ( )

d) did you take zidovudine? yes ( ) no ( )

13. a) Were infection control standards for blood-borne viruses: good ( ) poor ( )

b) Were sharps boxes readily available locally? yes ( ) no ( )

c) were gloves readily available locally? yes ( ) no ( )

d) If equipment was reused was it adequately sterilised? yes ( ) no ( )

e) Were you well supervised? yes ( ) no ( )

f) If the standards were poor can you give any examples?

14. a) How many percutaneous / mucosal exposures have you had during your clinical training excluding the elective?

none ( ) 1-5 ( ) 5-10 ( ) >10 ( )

b) Did you report: all ( ) or some ( ) or none ( ) of these to occupational Health or A and E?

 15) Do you feel that you have had adequate education / training in :

phlebotomy ? yes ( ) no ( )

infection control for blood-borne viruses? yes ( ) no ( )

risks of infection with blood-borne viruses? yes ( ) no ( )