Laserfiche WebLink
Apr 05 22 02:44p Century 21M&M &Assoc. 209-334-2550 p,5 <br />Hepatitis B Vaccine Declination Farm <br />The following statement of declination of the hepatitis B vaccine must be signed by <br />an employee who: <br />Chooses not to accept the vaccine. <br />Has had appropriate training regarding hepatitis B, hepatitis B vaccination, <br />the efficacy, safety, method of administration and benefits of vaccination, <br />given free of charge to the employee. <br />I understand that due to my occupational exposure to blood or other potentially <br />infectious materials I may be at risk of acquiring hepatitis B virus (HBV) infection. I <br />have been given the opportunity to be vaccinated with hepatitis B vaccine, at no <br />charge to myself. However, I decline hepatitis B vaccination at this time. I <br />understand that by declining this vaccine I continue to be at risk of acquiring <br />hepatitis B, a serious disease. If in the future I continue to have occupational <br />exposure to blood or other potentially infectious materials and I want to be <br />vaccinated with hepatitis B vaccine, I can receive the vaccination series at no charge <br />to me. �- <br />Employee <br />This statement is not a waiver; employees can request and receive the <br />hepatitis B vaccination at a later date if they remain occupat!Onally at risk for <br />hepatitis B. <br />An employer can not require: <br />Employees to waive liability in <br />order to receive <br />the <br />vaccine <br />Participation in pre screening <br />as a prerequisite <br />for <br />receiving the vaccine, <br />