Hepatitis B Vaccination Consent Waiver Form 2025

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  1. Click ‘Get Form’ to open the Hepatitis B Vaccination Consent Waiver Form in our editor.
  2. Begin by entering your Name and Department in the designated fields. This information is essential for identifying your request.
  3. Next, fill in the Date and Job Title. Accurate details help ensure proper documentation and processing of your consent.
  4. Review the options provided regarding the Hepatitis B vaccination series. Choose one of the three statements that best reflects your decision: acceptance, declination, or confirmation of prior vaccination.
  5. After selecting an option, sign the form electronically using our platform’s signature feature. This step is crucial for validating your consent.

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The Cal/OSHA Bloodborne Pathogen (BBP) standard requires that employers make available hepatitis B vaccine to unvaccinated employees at risk of occupational exposure. Employees may decline to be vaccinated with hepatitis B vaccine but must sign a declination form.
Of all respondents, 403 (54.8%) stated that they had never received the hepatitis B vaccine, of which 29.8% stated that they had not been previously vaccinated because of mistrust, 9.4% because their parents refused to have them vaccinated, 25.9% because they were never offered the vaccination, 16.4% because they did
Employers must ensure that workers who decline vaccination sign a declination form. The purpose of this is to encourage greater participation in the vaccination program by stating that a worker declin- ing the vaccination remains at risk of acquiring hepatitis B.
2) Hepatitis B Vaccine Waiver I have been given the opportunity to be vaccinated with hepatitis B vaccine at no charge to myself; however, ☐ I decline the hepatitis B vaccination at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring hepatitis B, a serious disease.
You can sign to either accept or decline the vaccination. If you decline now, you can accept it at a later date should you change your mind. Workers in jobs with a reasonable expectation of contact with blood and other potentially infectious materials tend to be at risk of hepatitis B through occupational exposure.
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