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BCAUTY & CO. <br />Declination Statement <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 charge <br />to me; however, I decline hepatitis B vaccination at this time. I understand that by <br />declining this 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 potentially <br />infectious materials and I want to be vaccinated with hepatitis B vaccine, I can receive <br />the vaccination series at no charge to me. <br />Sarah Miller <br />Employee Signatulre�:_I <br />Date: I l <br />