Health and Human Services

Population Health, Environmental Epidemiology

Rule 703: Injury Reporting Rule

Effective Date: 06/30/2026

Admin. Code Reference: R386-703

Rule Type: Current Rule

NOTICE OF SUBSTANTIVE CHANGE

TYPE OF FILING: Amendment

Rule or section number:

R386-703

Filing ID: 57910

Agency Information

1. Title catchline:

Health and Human Services, Population Health, Environmental Epidemiology

Building:

Cannon Health Building

Street address:

288 N 1460 W

City, state:

Salt Lake City, UT

Mailing address:

PO Box 142104

City, state and zip:

Salt Lake City, UT 84114-2104

Contact persons:

Name:

Phone:

Email:

Mark E. Jones

801-538-6191

markejones@utah.gov

Mariah Noble

385-214-1150

mariahnoble@utah.gov

Please address questions regarding information on this notice to the persons listed above.

General Information

2. Rule or section catchline:

R386-703. Injury Reporting Rule

4. Purpose of the new rule or reason for the change:

On October 28, 2021, the Center for Disease Control and Prevention (CDC) revised the elevated blood lead (Blood Lead Reference Value) from 5.0 mcg/dL to 3.5 mcg/dL to identify more children with lead in their blood, where there is no safe level of lead in a person's blood.

This amendment will align Utah with CDC's guidelines to provide assistance and educate parents of children having a blood lead level lower than Utah's current guidelines. The amendment will help to alleviate any disparities between Utah's state/local health departments and health care providers when assessing a child's exposure to lead in relation to this rule and CDC's guidelines.

5. Summary of the new rule or change:

This filing redefines an "elevated blood lead" from 5.0 mcg/dL to 3.5 mcg/dL, to be consistent with CDC's guidance.

In addition, style and formatting changes are also made in accordance with the Rulewriting Manual for Utah and to align this rule with other rules under the Department of Health and Human Services (department).

Fiscal Information

6. Provide an estimate and written explanation of the aggregate anticipated cost or savings to:

A. State budget:

There is no anticipated cost or savings to the state budget as a result of this filing because these changes fall within the current scope of work for the Environmental Epidemiology Program (program) and are not anticipated to produce a cost or savings for additional duties or work related to expanding the definition of elevated blood lead.

To implement this amendment, the program anticipates it will need to perform administrative tasks, but as these are already part of the state's process and are completed using the program's existing budget, they are not anticipated to introduce a cost.

The Utah State Hospital may have cases related to elevated blood lead levels, but there is no way of knowing how many additional cases could be attributed to this rule change.

B. Local governments:

There is an anticipated cost to local governments as a result of this filing.

The updated definition to lower the standard for identifying a case is anticipated to increase the number of cases identified by local governments and managed by the 13 local health districts in Utah by approximately 25%, based on 2023-2024 blood lead data.

Based on data from these years, there were approximately 107 cases of elevated blood lead, under the previous definition, and the average cost for managing a patient with elevated blood lead was about $500.

Therefore, under the updated definition, the department anticipates there would be about 134 cases of elevated blood lead annually, which is estimated to cost these local health districts a total of $67,000.

However, as a result of applying the updated definition of a case of elevated blood lead, there is an anticipated fiscal benefit, through contracts from an existing Childhood Lead Poisoning Prevention grant award from the CDC, that is anticipated to cover this annual cost of $67,000, though that amount may vary from year to year based on CDC funding for the grant.

The amount allocated and distributed to each local health district is calculated based on each local health district's percentage of the total number of individuals at or above the updated definition of elevated blood lead levels in the previous year.

Since the complete anticipated cost is anticipated to be covered by the grant award, these numbers are reflected in the regulatory impact summary table with a total net cost of $0.

C. Small businesses ("small business" means a business employing 1-49 persons):

This rule amendment may result in an inestimable indirect cost or savings to small businesses, depending on how many people need to be tested for blood lead and whether those people need to receive additional blood lead tests through a physician or clinic considered to be a small business.

While it is unknown exactly how many people will need to be tested, in past years, there have been an average of 280 people annually initially identified as having an unconfirmed or confirmed blood lead level of at least 3.5 mcg/dL.

It is also unknown how many tests each person will need, which physicians or clinics will issue these tests, and whether or not each person's test will conclude that the person has an elevated blood lead level, necessitating management by the physician and applicable local health district.

D. Non-small businesses ("non-small business" means a business employing 50 or more persons):

This rule amendment may result in an inestimable indirect cost or savings to non-small businesses, depending on how many people need to be tested for blood lead and whether those people need to receive additional blood lead tests through a physician or clinic considered to be a non-small business.

E. Persons other than small businesses, non-small businesses, state, or local government entities ("person" means any individual, partnership, corporation, association, governmental entity, or public or private organization of any character other than an agency):

This rule amendment may result in an inestimable indirect cost or savings to individuals who are tested and treated for elevated blood lead as a result of this filing.

Although this filing does not change the process for treatment, the filing changes what levels of blood lead are considered elevated blood lead, and a person who has elevated blood lead is required to receive follow-up blood tests until two consecutive blood tests are below 3.5 mcg/dL and annually thereafter.

While it is likely more cases of elevated blood lead and follow-up testing will occur, it is impossible to know the financial circumstances of each individual and how ongoing testing may result in a cost or savings.

F. Compliance costs for affected persons:

While any compliance costs for small businesses, non-small businesses, and other persons are inestimable because it is impossible to know which individuals with a case of elevated blood lead will patronize which businesses for testing, it is anticipated that the compliance cost for an individual local health authority, of which there are 13 total in the state, would fall within an approximate range of $3,000 to $8,600 for increased testing and case management, depending on the size and scale of that local health authority.

G. Regulatory Impact Summary Table (This table includes only fiscal impacts the agency was able to measure. If the agency could not estimate an impact, it is excluded from this table but described in boxes A through F.)

Regulatory Impact Summary Table

Fiscal Cost

FY2026

FY2027

FY2028

FY2029

FY2030

State Budget

Local Governments

$67,000

Small Businesses

Non-Small Businesses

Other Persons

Total Fiscal Cost

$67,000

Fiscal Benefits

FY2026

FY2027

FY2028

FY2029

FY2030

State Budget

Local Governments

$67,000

Small Businesses

Non-Small Businesses

Other Persons

Total Fiscal Benefits

$67,000

Net Fiscal Benefits

H. Department head comments on fiscal impact and approval of regulatory impact analysis:

The Commissioner of the Department of Health and Human Services, Tracy S. Gruber, has reviewed and approved this regulatory impact analysis.

Citation Information

7. Provide citations to the statutory authority for the rule. If there is also a federal requirement for the rule, provide a citation to that requirement:

Section 26B-7-113

Section 26B-7-202

Public Notice Information

9. The public may submit written or oral comments to the agency identified in box 1.

A. Comments will be accepted until:

06/16/2026

10. This rule change MAY become effective on:

06/23/2026

NOTE: The date above is the date the agency anticipates making the rule or its changes effective. It is NOT the effective date.

Agency Authorization Information

Agency head or

designee and title:

Tracy S. Gruber, Commissioner

Date:

04/19/2026

R386. Health and Human Services, Population Health, Environmental Epidemiology.

R386-703. Injury Reporting Rule.

R386-703-1. Authority and Purpose[ Statement].

(1) [The Injury Reporting Rule is adopted under authority of ]Sections 26B-7-113 and 26B-7-202 authorize this rule.

(2) This [e Injury Reporting R]rule establishes an injury surveillance and reporting system for specified injuries with the intent of

identifying the risk factors that contribute to the causes of injury that can be ameliorated, thereby reducing morbidity and mortality.

R386-703-2. Definitions.

(1)(a) "Acute [T]traumatic [B]brain [I]injury" means a head injury of sufficient severity to cause death or to require admission to a health

care facility.

(b) Acute traumatic brain injuries may be associated with transient or persistent neurological dysfunction and may be diagnosed as brain

concussions, brain contusions, or traumatic intracranial hemorrhages.

(2) "Acute [S]spinal [C]cord [I]injury" means a traumatic injury to the contents of the spinal canal, spinal cord, or cauda equina, which

result in death or [which result in ]transient or persistent neurological dysfunction of sufficient severity to require health care facility admission.

(3) "Agency" means the health care facility or laboratory at which a reportable injury is treated or evaluated.

(4) "Asphyxiation" means an injury which arises from atmospheric oxygen deprivation or from traumatic respiratory obstruction which results in death or is of sufficient severity to require admission to a health care facility.

(5) "Authorized [H]health [P]personnel" means a person representing the [D]department or a local health department who [is authorized

to]may inspect medical records for injury investigations.

(6) "Blunt [F]force [I]injury" means [a blunt force]an injury caused by a non-penetrating impact which results in death or is of sufficient

severity to require admission to a health care facility.

[

](7) "Burn[s]" means an injury resulting from acute thermal exposure or exposure to fire which results in death or is of sufficient severity to

require admission to a health care facility.

(8) "Chemical [P]poisoning" means any case where a person has an acute exposure to toxic chemical substances which result in death or

require admission to a health care facility or emergency department evaluation.

(9) "Department" means the [Utah ]Department of Health and Human Services.

(10) "Drowning" [and "Near Drowning" ]means a water immersion injury resulting in death[ and any water immersion injury of sufficient

severity to require admission to a health care facility].

(11) "Electrocution" means an injury arising from exposure to electricity which results in death or is of sufficient severity to require admission to a health care facility.

(12) "Elevated [B]blood [L]lead" means any case where a person has a blood lead concentration equal to or greater than 3.5 micrograms

per deciliter.

(13) "Health [C]care [F]facility" means the same as defined in [Title 26B, Part 2, Health Care Facility Licensing and Inspection]Section

26B-2-201.

(14) "Individual" means the medical examiner, head start coordinator, or licensed medical personnel of a private office who treated or evaluated a reportable injury.

(15) "Injury" means bodily damage resulting from exposure to physical agents including mechanical energy, thermal energy, ionizing radiation, or chemicals, or resulting from the deprivation of basic environmental requirements including oxygen or heat.

(16) "Injury [R]related to [S]substance [A]abuse" means any case of injury resulting in death or hospitalization and associated with an

event involving alcohol or drug intoxication of any person[ involved in the injury occurrence].

(17) "Intentional [I]injury[ies]" means any case of:

(a) suicide or attempted suicide resulting in admission to a health care facility; or

(b) [any case of ]homicide, attempted homicide, or battery resulting in hospitalization.

(18) "Laboratory" [is defined as]means any clinical laboratory, physician office, health care facility, health clinic, reference laboratory, or

[any ]facility that performs blood lead analysis.

(19) "Local health department" [has the same meaning]means the same as defined in Section 26A-1-102.

(20) "Local health officer" means the executive director, or a designated representative, of the [jurisdictional ]local health department

responsible for the geographic area where an injury occurs[ or a designated representative].

(21) ["Mechanical Energy Injuries" means acceleration and deceleration injuries, blunt trauma, and penetrating wound injuries.]"Near

drowning" means any water immersion injury of sufficient severity to require admission to a health care facility.

(22) "Office of Communicable Diseases" means the Office of Communicable Diseases in the Division of Population Health in the department[Utah Department of Health and Human Services].

(23) ["Office of Emergency Medical Services and Preparedness" means the Office of Emergency Medical Services and Preparedness in the

Division of Population Health in the Utah Department of Health and Human Services.

(24) ]"Office of Vital Records and Statistics" means the Office of Vital Records and Statistics in the Division of Data, Systems and

Evaluation in the department[Utah Department of Health and Human Services].

([25]24) "Traumatic [A]amputation[s]" means an unintended [traumatic ]amputation of a limb or part of a limb which results in death or

[which ]requires admission to a health care facility or emergency department treatment.

R386-703-3. Reportable Injuries.

(1) As outlined in Section R386-703-4, an individual or agency shall report [the following ]to the appropriate entity, as described in

Section R386-703-6,[Department as outlined in Section R386-703-4] each:

[(a) chemical poisoning, except unintentional adverse health effects resulting from the use of pharmacological agents as prescribed by a

physician do not require reporting under this rule;

(b) acute traumatic brain injury;

(d) blunt force injury;

(e) drowning and near drowning;

(f) asphyxiation;

(g) burns;

(h) electrocution;

(i) intentional injuries;

(j) injuries related to substance abuse;

(k) traumatic amputation; and

(l) each blood lead test result.

](a) acute spinal cord injury;

(b) acute traumatic brain injury;

(d) blood lead test result;

(e) blunt force injury;

(f) burn;

(g) chemical poisoning, unless the chemical poisoning is an unintentional adverse health effect from the use of a prescribed

pharmacological agent;

(h) drowning and near drowning;

(i) electrocution;

(j) injury related to substance abuse;

(k) intentional injury; and

(l) traumatic amputation.

(2) In the case of an elevated blood lead test result, if the initial test result was from a capillary blood sample, the attending individual or

agency shall confirm each case of elevated blood lead by [either ]a venous or another capillary blood sample.

R386-703-4. Report Requirements[:] for Blood Lead Testing Results.

(1) When reporting a [non-case ]blood lead result that is not elevated, the individual or agency [taking]that collected the sample shall

provide in each report[ the following information for the person being tested]:

(a) the name of the reporting individual or agency; and

(b) for the person who was tested, that person's:

([a]i) name;

([b]ii) date of birth, or age if the date of birth is unknown;

([c]iii) sex; and

([d]iv) zip code[; and

(e) the individual or agency submitting the report].

(2) When reporting a case of elevated blood lead, the individual or agency [taking]that collected the sample shall provide in each report[

the following information with each injury report pertaining to the injured person]:

(a) the name of the reporting individual or agency; and

(b) for the person who was tested, that injured person's:

([a]i) name;

([b]ii) date of birth, or age if the date of birth is unknown;

([c]iii) sex;

([d]iv) address of residence; and

(v) disposition;

([e]i) date of occurrence[injury];

([f]ii) type[ of injury];

([g]iii) external cause[ of injury];

([h]iv) locale on the person's body[of injury]; and

(v) relation to the person's occupation; and

([i]d) whether any injury to the person who was tested is an intentional injury[intentionality;

(j) relation of injury to occupation;

(k) disposition of the injured person; and

(l) the name of the individual or agency submitting the report].

(3) The [D]department shall adopt a standard report format which [may]shall be supplied to an individual or agency[reporting sources]

upon request.

R386-703-5. [Report Requirements: Agencies or Individuals Required to Report Injuries.

Each individual or agency treating or evaluating a reportable injury shall report the injury as required in Sections R386-703-3 through

R386-703-7.

R386-702-6. Report Requirements: ]Time Requirements for Reports.

(1) An individual or agency required to report a reportable injury listed in Section R386-703-3 shall submit the report within 60 days of the

[time]date of diagnosis or recognition of injury.

(2) In the event of an unusual or excessive occurrence of a reportable injury[injuries], [an]the individual or agency required to report shall

immediately report by telephone to the local health officer or [to ]the [D]department.

R386-703-[7]6. [Report Requirements: ]Report Destination Requirements.

(1) [Except in (a), (b), and (c), a]An individual or agency shall report any reportable injury listed in Section R386-703-3 to the Office of

Communicable Diseases or to the local health department responsible for the geographic area where the injury occurred, except as described in

Subsections (1)(a), (1)(b), and (1)(c).

(a) When a case of a reportable injury results in death, [an]the reporting individual or agency[ reporting a reportable injury] may submit a

completed death certificate to the Office of Vital Records and Statistics in lieu of reporting to the Office of Communicable Diseases.

(b)[ In the case where an injury is evaluated in an emergency department of a health care facility, the health care facility may, in lieu of

reporting to the Office of Communicable Diseases, submit a complete emergency department log to the Office of Emergency Medical Services and

Preparedness if the records are submitted through an electronic medium and format acceptable to the Office of Emergency Medical Services and

Preparedness.

(c)] In [the]a case where a reportable injury[ listed in Section R386-703-3] is reported under the requirements of Title 26B, Chapter 8, Part

5, Utah Health Data Authority, the individual or agency may:

(i) grant permission to the [D]department in writing that information relating to a case [with]of a reportable injury may be supplied to the

Office of Communicable Diseases before the identifying information is removed from the report; or

(ii) report the injury both in accordance with Title 26B, Chapter 8, Part 5, Utah Health Data Authority, and to the Office of Communicable Diseases.

(2)(a) [The]A local health officer shall forward each original report to the Office of Communicable Diseases.

(b) The local health department may maintain a copy[ies] of [these]the original report[s].

R386-703-[8]7. Special Investigations of Injury.

(1) The [D]department and local health officer may conduct an epidemiologic investigation[s] of any reportable injury, including the

collection of additional information pertaining to risk factors, medical condition, and circumstances of an injury.

(2) A individual or agency required to submit a report[s] in Section R386-703[(5)]-3 shall, upon request by the [D]department [and]or the

local health officer, provide authorized health personnel [the authority]access to inspect medical records [of]related to a reportable injury[ies].

(3) The Utah Labor Commission, Department of Public Safety, Department of Transportation, [Utah Industrial Commission, Utah

Department of Public Safety, ]and any local public safety agency[ies] shall make information on any reportable injury available to authorized health

personnel[ information on reportable injuries].

R386-703-[9]8. Confidentiality of Reports.

(1) Each report required in Section R386-703-3 is confidential and is not open to public inspection.

(2) The [D]department shall maintain the confidentiality of [personal ]information obtained under this rule [according to ]in accordance

with Sections 26B-7-217 through 26B-7-220.

(3) Nothing in this rule precludes the discussion of case information with the attending individual, agency, or authorized health personnel.

R386-703-[10]9. Penalties.

Enforcement provisions and penalties for the violation [or for the enforcement ]of public health rules, including [Rule R386-703]this rule,

are prescribed under Sections 26B-1-222 through 26B-1-224.

KEY: report, injury, blood lead

Date of Last Change: [November 5, 2023]2026

Notice of Continuation: July 1, 2025

Authorizing, and Implemented or Interpreted Law: 26B-7-113; 26B-7-202

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