Name of the deceased

Date of birth

Address

Date of death

To the best of my knowledge, the deceased’s remains are a potential source of infection:

Yes  /  No  

(Ring as appropriate – see note 1 below)

If yes (see note 2), the remains present a risk of transmission by (ring as appropriate)

Inoculation

Aerosol

Ingestion

In view of this risk, we advise;

Body bagging is advised

Viewing is not recommended

Embalming presents a high risk

(Ring one or more as appropriate)

Signed (note 3)

Person signing to print name in block capitals

Notes

Note 1: Not all infected patients display typical symptoms, therefore some infections (including blood-borne viral infections) may not have been identified at the time of death.

Note 2: In accordance with health and safety law.

Note 3: In hospital cases, the doctor certifying death is asked to sign this notification sheet; where a post-mortem examination has been undertaken, the pathologist may issue a new sheet updating the information; in non-hospital situations, either the doctor certifying death is asked to sign this sheet or the bereavement officer may sign on his behalf.

Note 4: in the event of a sharps injury in a case that constitutes an inoculation risk, the funeral director is advised to send the person who sustained the injury directly to the Accident and Emergency Department at Wythenshawe Hospital, accompanied by this sheet.  The hospital will identify the nature of the risk and give prophylaxis if appropriate.  Such prophylaxis may need to be given within one hour for maximum efficacy.

This information is supplied in conformity with the recommendation of the Health and Safety Executive document Controlling the risks of infection at work from human remains (available at www.hse.gov.uk/pubns/web01.pdf)