Laserfiche WebLink
Hepatitis B Vaccine Declination For <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 Signature: e: <br />