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HEPATITIS B VIRUS ACCEPTANCE OR DECLINATION FORM

HEPATITIS B VIRUS ACCEPTANCE OR DECLINATION FORM 2025

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The document is a Hepatitis B Virus (HBV) Vaccine Declination Form from The University of Texas Health Science Center at San Antonio. It outlines the risks associated with occupational exposure to HBV and provides an opportunity for employees to decline vaccination while acknowledging their continued risk. Employees can receive the vaccine at no charge in the future if they choose to do so. The form requires signatures from both the employee and a supervisor, and it mandates retention in the employee's medical record for 30 years post-employment.

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Click ‘Get Form’ to open the HEPATITIS B VIRUS ACCEPTANCE OR DECLINATION FORM in the editor.
Begin by entering your name in the designated field for 'Employee’s name (printed)'. This ensures that your identity is clearly documented.
Next, fill in your department in the corresponding section. This helps maintain accurate records within your organization.
Proceed to sign the form by adding your signature in the 'Employee’s signature' field. This confirms your decision regarding vaccination.
Have a supervisor or witness sign in the 'Supervisor / Witness signature' area to validate the declination statement.
Enter your HSC Badge Number and today's date in their respective fields to complete the form accurately.
Once all fields are filled, review the document for accuracy before saving or exporting it for record-keeping.

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What is a HepB declination form?

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.

Why do people refuse the Hep 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 employee 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 to do if you are HEPA B positive?

If you are diagnosed with hepatitis B, see your doctor to determine the best treatment for you. It will depend on a few factors, like whether you have early or long-term infection, the health of your liver, and what medications are available.

Can you decline the hepatitis B vaccine?

Employees may decline HBV vaccination. If declined, the employee must sign an HBV Declination Form (Appendix E).