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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 />