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Health hepatitis b declination statement

Health hepatitis b declination statement 2026

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The document is a Hepatitis B Declination Statement from the New Jersey Department of Health's PEOSH Unit, where an employee acknowledges the risk of hepatitis B due to occupational exposure and declines the vaccination offered at no cost. It informs the employee that they can opt for the vaccination in the future if desired.

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Click ‘Get Form’ to open the health hepatitis B declination statement in the editor.
Begin by entering your name in the 'Name of Employee (Print)' field. Ensure that your name is clearly legible.
Next, sign the document in the 'Signature of Employee' section. This confirms your understanding and decision regarding the vaccination.
Finally, enter the date on which you are completing this form in the designated 'Date' field. This is important for record-keeping purposes.

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2013	4.8 Satisfied (170 Votes)

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How to decline the Hep B vaccine?

I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring hepatitis B virus (HBV) infection. I have been given the opportunity to be vaccinated with hepatitis B vaccine, at no charge to me; however, I decline hepatitis B vaccination at this time.

What is declination of hepatitis B vaccine?

DECLINATION: I understand that due to my occupational exposure to blood or other poten tially infectious materials that I may be at risk of acquiring Hepatitis B Virus (HBV) infection. I have been given the opportunity to be vaccinated with Hepatitis B vaccine. However, I decline Hepatitis B vaccination at this time.

What is a hep 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.

What is hepatitis B declination?

A hepatitis B declination form is a form your employer may give you to offer you the hepatitis B vaccine option due to the occupational risk of exposure to the virus.

What does it mean if hep B is nonreactive?

document the refusal of one or more recommended immunizations.

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