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Hepatitis B Vaccine Declination Form

Occupational Safety And Health Administration

Bloodborne Pathogens Training – The Hepatitis Vaccine
  • 1910.1030 App A – Hepatitis B Vaccine Declination
    • Part Number:
    • Occupational Safety and Health Standards
    • Subpart:
    • Hepatitis B Vaccine Declination
    • GPO Source:e-CFR

    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 infection. I have been given the opportunity to be vaccinated with hepatitis B vaccine, at no charge to myself. However, I decline 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. If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with hepatitis B vaccine, I can receive the vaccination series at no charge to me.

    Can You Decline The Hepatitis B Vaccine For Newborn

    For instance, sometimes the hepatitis B vaccination is delayed if a baby is premature, has a low birth weight, or is medically challenged. Still, parents always have the option to refuse a vaccination if they want to. But the risks associated with a hepatitis B infection far outweigh the risks of the vaccine.

    What Is A Declination Form For Hepatitis B Vaccine

    I Decline the Hepatitis B Vaccination I have been given the opportunity to be vaccinated with hepatitis B vaccine, at no charge to myself. However, I decline 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.

    Also Check: How To Tell If You Have Hepatitis C

    How To Fill Out Maryland Hepatitis B Vaccine Acceptance Declination Form

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    Hepatitis B Declination Statement*

    Hepatitis B Vaccine Documentation Form

    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 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. I understand that by declining this vaccine I continue to be at risk of acquiring hepatitis B, a serious disease. If, in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with hepatitis B vaccine, I can receive the vaccination series at no charge to me.

    Employee Signature: Date:

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