Laserfiche WebLink
I understand that due,to my occupational exposure to blood or other potentially infectious <br />materials I maybe at risk of acgttiring or transmitting Hepatitis B virus (HBV) infections. <br />However, I decline Hepatitis.B vaccination at this time. I 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 infections <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 dccupational <br />Exposer -e tto BeloodbornPathogens. Occupational Safety and Health Act. <br />- <br />I, b me S G have decided not to receive injections of <br />(Print Name) <br />I;lYolicy and Legal C13P\Hea1tU Foims,Crim Bkb -d Cl�cl;, dna screen, fiugerpru�t for Students�ITealcU <br />Forms 2011.7_0121Hep B Vaccine Decline Form.doc <br />