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Click ‘Get Form’ to open the hepatitis B declination form in the editor.
Begin by reviewing Section 1, where you will confirm that you have received training on bloodborne pathogens. Check the box to indicate your acknowledgment.
Move to Section 2. Here, you must choose one of the options regarding the Hepatitis B vaccination. If you have received the vaccination, check the first box and enter the date of your last vaccination.
If you decline the vaccination, check the second box. Ensure you read and understand the implications of declining, as it states your awareness of potential risks.
If you accept participation in the vaccination program, check the third box to indicate your wish to receive the vaccine series.
Finally, fill in your name, signature, department, and date at the bottom of the form before saving or exporting your completed document.
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Declination form means the form that is signed by and collected from Clients who decline voter registration services. A Client refusing to sign the Voter Registration Form is also a Declination.
Why do people refuse the Hep B vaccine?
The Advisory Committee on Immunization Practices (ACIP) recommends hepatitis B (HepB) vaccination among all infants at birth, unvaccinated children younger than 19 years of age, adults aged 1959 years, and adults aged 60 years and older with risk factors for hepatitis B or without identified risk factors but seeking
What is the OSHA statement for hepatitis B declination?
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 the short form of hepatitis B vaccine?
Employees may decline HBV vaccination. If declined, the employee must sign an HBV Declination Form (Appendix E).
What is a declination form for the hepatitis B vaccine?
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.
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I have previously completed the Hepatitis B Series of vaccinations. I wish to receive the Hepatitis B vaccine. I decline to receive the Hepatitis B vaccine.
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