Laserfiche WebLink
Student Hepatitis B Vaccine Declination <br /> I understand that due to my occupational.exposure to blood or other potentially infectious <br /> materials I may be at risk of acquiring or transmitting Hepatitis B virus (HBV) infectious. <br /> However, I decline Hepatitis B vaccination at this time. 1 understand that by declining <br /> this vaccine, I continue to be at risk of acquiring Hepatitis B, a serious disease. If, in the <br /> ,future, I continue to have occupational exposure to blood or other potentially infectious <br /> materials and I want to be vaccinated with Hepatitis B vaccine, I may do so. <br /> Reference: Appendix A, 29 Code of Federal Regulations 1910.1030 Occupational <br /> Expose to loodborne Pathogens Occupational Safety and Health Act. <br /> I, a MAKJA have decided not to receive injections of <br /> (Print Name) <br /> fis , <br /> Date Signature <br /> IAPolicy and Legal CHMeaIth horms,Crirn Bkgrd Click,drug screen,fingerprint for StudentsTlealth <br /> Forms 2011.20121IIep B Vaccine Decline Porm.doc <br />