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Hepatitis b waiver form

Hepatitis b waiver form 2026

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4.8 out of 5

62 votes

The document is a Hepatitis B Vaccine Acknowledgement/Waiver form for employees at Yale University. It informs employees about their potential risk of Hepatitis B Virus (HBV) infection due to occupational exposure and offers them the option to receive the vaccine free of charge. Employees can choose to be vaccinated, decline the vaccine, or confirm prior vaccination. The form requires personal information and must be returned to the Environmental Health & Safety Training Coordinator.

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Click ‘Get Form’ to open the hepatitis B waiver form in the editor.
Begin by entering your name in the designated field. Ensure that it is printed clearly for identification purposes.
Next, select one of the options regarding your vaccination preference. You can choose to be vaccinated, decline the vaccine, or indicate that you have already received it. Make sure to check the appropriate box.
Fill in your department and NetID in the respective fields to provide additional context about your employment.
Enter your telephone number, ensuring it is during business hours (8:30 a.m. - 5:00 p.m.) for any follow-up communications.
Finally, sign and date the form at the bottom to confirm your choices and understanding of the information provided.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (62 Votes)
2016	4.3 Satisfied (102 Votes)

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What is hepatitis B waiver?

I understand that by declining this vaccine, I continue to be at risk of acquiring hepatitis B, a serious disease. In the future, if I continue to have occupational exposure to human blood or OPIM and I want to be vaccinated with hepatitis B vaccine, I can receive the vaccination series at no charge to myself.

Can I delay the Hep B vaccine at birth?

Evidence Snapshot The hepatitis B vaccine has been tested extensively for safety and efficacy, and when administered within 24 hours of birth it is highly effective in preventing newborn infection.

What is a 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.

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