My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
COMPLIANCE INFO
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
E
>
88 (STATE ROUTE 88)
>
13500
>
4100 – Safe Body Art
>
PR0541030
>
COMPLIANCE INFO
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
11/20/2024 9:23:24 AM
Creation date
7/3/2020 10:13:43 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0541030
PE
4120
FACILITY_ID
FA0023514
FACILITY_NAME
THE RAVEN TATTOO & ART GALLERY (FREDERICKSEN, ROBERT)
STREET_NUMBER
13500
STREET_NAME
STATE ROUTE 88
City
LOCKEFORD
Zip
95237
CURRENT_STATUS
02
SITE_LOCATION
13500 HWY 88
QC Status
Approved
Scanner
SJGOV\cfield
Supplemental fields
FilePath
\MIGRATIONS\BA\BA_4120_PR0541030_13500 HWY 88_.tif
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
54
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
I undensiand that due to my occupational exposure,to blood Or Other I)OIeWililly illfVC6011S <br /> malerial-,I may be at risk of accl"Iring. or transmitting Hepatitis B virus (IIBV) infectiolls. <br /> Flowever, I clecline Tlepatil is B vaccination at this time. I understand that b�, declinim-- <br /> tills vaccine. I continue to be at risk of acquiring I lepatilis B. a serious clusease. If, In the <br /> I'LI11,11'e. I COVIIiII11C 10 have Occapational exposilre to blood or other potentially Infectious <br /> materials and I want to be vaccinated with Hepatitis B vaccine, 1 may do so. <br /> Reference: Appendix A- 29 Code of Federal Regulations 1910.1030 Occupational <br /> Z� <br /> HApostire to Bloodborne Pathogens. Occupational Safety 1111d,licaltil Act. <br /> have.decided uO to receive Injections of <br /> (Print Name) <br /> alr Sianature <br /> 1APolicy and Legal CH11\1-fealift Forms,Crhn Bkord Click,(tru-sci-mu,fingi-rprim for StudentAl leal III <br /> Norms 2011.2(312\1-left R Vaccine Decline Form.doc <br />
The URL can be used to link to this page
Your browser does not support the video tag.