WV Needlestick Injury Prevention Program (NIPP) Contact Form
350 Capitol Street, Rm 125
Charleston, West Virginia 25301-3715
Phone (304) 558-5358
FAX (304) 957-0185
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NEEDLESTICK REPORTING CONTACT INFORMATION FORM 

Hospitals, nursing homes, home health agencies, and local health departments are required to report needlestick and sharp object injuries to the Director of the Division of Health under West Virginia Code 16-36 and Legislative Rule 64CSR82. This form should be used to notify the West Virginia Needlestick Injury Prevention Program (WVNIPP) of current reporting contact information. 

Facilities Currently Reporting – If your facility has been reporting injuries to the WVNIPP and you know your WVNIPP 4-Digit Facility Code, please complete this form if you have a change in your facility contact, facility name, facility address, phone number, fax number, or contact e-mail address.

New Facilities – If you are a new facility that must begin reporting injuries to the WVNIPP, or if your facility has never been assigned a facility code, please contact by emailing needlestickreporting@wv.gov to obtain your facility code and complete the information below.


WVNIPP 4-Digit Facility Code
Type of Facility *
Facility Name *
Facility Mailing Address (include street, city, and zip)  Please ALSO indicate physical street address if PO Box address *
Reporting Contact Name *
Contact Phone Number (include area code) *
Contact Fax Number (include area code)
Contact Email Address *
Form Completed By *
Date  *
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