Printable Hep B Declination Form Hepatitis B Vaccine Declination Mandatory 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 HBV infection I have been given the opportunity to be vaccinated with hepatitis B vaccine at no charge to myself
The following statement of declination of hepatitis B vaccination must be signed by an employee who chooses not to accept the vaccine The statement can only be signed by the employee following appropriate training regarding hepatitis B hepatitis B vaccination the efficacy safety method of administration and benefits of vaccination and that the vaccine and vaccination are provided free HEPATITIS B VACCINE CONSENT DECLINATION FORM HEPATITIS B Hepatitis B is a viral infection caused by the Hepatitis B virus HBV which causes death in 1 2 of patients including more than 300 healthcare workers annually Most people with Hepatitis B recovers completely but about 5 10 of infected individuals become chronic carriers of
Printable Hep B Declination Form
Printable Hep B Declination Form
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HEPATITIS B VIRUS HBV DECLINATION FORM HEPATITIS B Hepatitis B is a viral infection of the liver caused by Hepatitis B virus HBV About 1 25 million people in the U S have chronic Hepatitis B virus infection Each year approximately 300 000 new infections are reported to the Center for Disease Control HEPATITIS B VACCINE DECLINATION SHOT RECORD FORM I have already completed the Hepatitis B vaccination series understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring the hepatitis B virus HBV infection I have been given the opportunity to be vaccinated with the
WCU Safety Risk Management Hepatitis B Vaccination Declination Form Rev 4 1 2020 Hepatitis B Vaccination Declination Form INSTRUCTIONS Every employee covered by the OSHA Bloodborne Pathogens Standard must complete EITHER this declination form OR the Hepatitis B Vaccination consent form and return it to the Safety and Hepatitis B Immunization Review and Declination Form Instructions This form fulfills OSHA s Bloodborne Pathogen Standards requirement for Hepatitis B vaccination Complete each section and submit the completed form along with any accompanying vaccination records to the Department of Environmental Health Safety and Risk Management
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Hepatitis B Vaccine Declination mandatory Print Name Job Title Department Rev 4 16 2018 Occupational Health Services 10833 Le Conte Avenue CHS Bldg Suite 67 120 Los Angeles CA 90095 Tel 310 825 6771 Fax 310 206 4585 Title Hepatitis B Vaccination Acceptance or Declination Form Instructions Complete the Employee Student information below Determine whether or not you wish to receive the vaccine at no charge Check either the Acceptance or Declination section and submit form to the EHS Office by fax or email at 757 683 6025 or ehsdept odu edu Name
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 You can sign to either accept Hepatitis B vaccination of adults occupational health providers MMWR Updated U S Public Health Service Guidelines for the Management of Occupational Exposures to HBV HCV and HIV and Recommendations for Postexposure Prophylaxis Recommended dosages schedules of hepatitis A vaccines and hepA hepB combination vaccines
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https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030AppA
Hepatitis B Vaccine Declination Mandatory 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 HBV infection I have been given the opportunity to be vaccinated with hepatitis B vaccine at no charge to myself
https://www.osha.gov/etools/hospitals/hospital-wide-hazards/biological-hazards/declination
The following statement of declination of hepatitis B vaccination must be signed by an employee who chooses not to accept the vaccine The statement can only be signed by the employee following appropriate training regarding hepatitis B hepatitis B vaccination the efficacy safety method of administration and benefits of vaccination and that the vaccine and vaccination are provided free
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Printable Hep B Declination Form - HEPATITIS B VIRUS HBV DECLINATION FORM HEPATITIS B Hepatitis B is a viral infection of the liver caused by Hepatitis B virus HBV About 1 25 million people in the U S have chronic Hepatitis B virus infection Each year approximately 300 000 new infections are reported to the Center for Disease Control
