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Health Declaration and Immunisation Forms 2026

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The document is a Hepatitis B Vaccine Declaration Form from Stanford's Occupational Health Services. It outlines the process for employees and students to declare their eligibility for the Hepatitis B vaccination based on potential workplace exposure to bloodborne pathogens. The form includes sections for supervisors to confirm vaccination eligibility and for employees to either request the vaccine or decline it, along with reasons for declination. It emphasizes the importance of vaccination in preventing Hepatitis B infection among those at risk due to their occupational duties.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your personal information in the designated fields, including your name, student ID, email, and contact number. Ensure all details are accurate for effective communication.
Next, indicate your employment status by selecting the appropriate box. This helps determine your eligibility for vaccination based on your role.
Supervisor/PI must complete the confirmation section regarding vaccination eligibility. They should provide their name, phone number, signature, and date.
As an employee, choose one of the two sections: either request to receive the Hepatitis B vaccine series or decline it. If declining, check applicable reasons and provide a signature with the date.
Finally, review all entries for accuracy before submitting the form via fax or email as instructed at the bottom of the document.

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Versions	Form popularity	Fillable & printable
2017	4.9 Satisfied (41 Votes)
2016	4.7 Satisfied (52 Votes)

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Which immunizations are required for immigration?

The Immigration and Nationality Act (INA) requires applicants to submit documentation of having received the following vaccinations: Mumps, measles, rubella; Polio; Tetanus and diphtheria toxoids; Pertussis; Haemophilius influenza type B; and. Hepatitis B.

What medical tests are required for US immigration?

The medical examination will include a medical history review, physical examination, chest X-ray and blood tests for syphilis. The physical examination will at least include examination of the eyes, ears, nose and throat, extremities, heart, lungs, abdomen, lymph nodes and skin.

Which vaccines are absolutely necessary?

Vaccination Requirements Mumps; Measles; Rubella; Polio; Tetanus and Diphtheria Toxoids; Pertussis; Haemophilus influenzae type B; Hepatitis B; and.

How do I write a self-declaration for health?

I declare that I am not suffering from any infectious, chronic or any other disease, which makes me, unfit. 2. I also declare that I am not suffering from asthma, epilepsy or any other medical problem which requires immediate medical attention.

What is the health declaration form?

We use this form to record your declaration regarding your health and any relevant medical conditions. We may also ask you to complete this form to help us determine whether you are suitable to continue in post if there are any docHub changes in your health while registered.

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