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Hepatitis B Vaccination Consent Waiver Form

Hepatitis B Vaccination Consent Waiver Form 2025

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The document is a Hepatitis B Vaccination Consent/Waiver Form for employees who may come into contact with human blood or potentially infectious materials. It outlines the availability of the Hepatitis B vaccine series and medical consultation at no cost after completing Bloodborne Pathogens training. Employees can choose to accept the vaccination, decline it while acknowledging the risks, or indicate they have already been vaccinated and can provide documentation.

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Click ‘Get Form’ to open the Hepatitis B Vaccination Consent Waiver Form in the editor.
Begin by entering your Name and Department in the designated fields. This information is essential for identifying your request.
Next, fill in the Date and Job Title. Accurate details help ensure proper documentation and processing of your consent.
Review the options provided regarding your choice for receiving the Hepatitis B vaccination series. Select one of the three statements that best reflects your decision.
If you choose to accept the vaccination, ensure you sign in the Signature field to confirm your consent.
Once all fields are completed, save your document. You can then download or share it directly from our platform for free.

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Versions	Form popularity	Fillable & printable
2019	4.7 Satisfied (44 Votes)
2018	4.4 Satisfied (30 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Is the hepatitis B vaccine mandatory?

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.

Can you decline the hepatitis B vaccine?

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

Can an individual decline the hepatitis B vaccine?

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.

What is hepatitis B waiver?

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.

Can I refuse the Hep B vaccine?

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.