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COMPLIANCE INFO
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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E
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ELEVENTH
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18
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4100 – Safe Body Art
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PR0548552
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COMPLIANCE INFO
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Entry Properties
Last modified
11/19/2024 10:19:27 AM
Creation date
8/11/2023 1:16:49 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4100 – Safe Body Art
File Section
COMPLIANCE INFO
RECORD_ID
PR0548552
PE
4110
FACILITY_ID
FA0027757
FACILITY_NAME
IN BLOOM TATTOO & PIERCING (BAXTER, KOEDY)
STREET_NUMBER
18
Direction
E
STREET_NAME
ELEVENTH
STREET_TYPE
ST
City
TRACY
Zip
95377
CURRENT_STATUS
01
SITE_LOCATION
18 E ELEVENTH ST
P_LOCATION
03
QC Status
Approved
Scanner
SJGOV\cfield
Tags
EHD - Public
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Hepatitis B Vaccine Declination (Mandatory) <br />I understand that due to my occupational exposure to blood or othe <br />potentially infectious materials I may be at risk of acquiring Hepatitis B <br />Virus (HBV) infection. I have been given the opportunity to be vaccinat_U <br />with Hepatitis B vaccine, at no charge to myself. However, I decline <br />Hepatitis B vaccination at this time. I understand that be declining this <br />vaccine, I continue to be at risk of acquiring Hepatitis B, a serious disease. <br />If in the future I continue to have occupational exposure to blood or other <br />potentially infectious material and I want to be vaccinated with Hepatitis B <br />vaccine, I can receive the vaccination series at no charge to me. <br />S <br />Date: <br />The vaccine must be made available to all employees with <br />occupational exposure, regardless of how often the exposure may occur. <br />Part-time and temporary employees are includes in this coverage. <br />The employer does not have to offer the vaccine series if one of the <br />following exemption are documented in employees medical record. <br />a. Signature on mandatory declination form. <br />b. The complete hepatitis B vaccination series was previously <br />received (the vaccine shots or in the case of a non -responder, <br />six). <br />C. Antibody testing shows the employee to be immune. <br />d. The vaccine cannot be given for medical reasons. <br />
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