I understand the benefits and risks of hepatitis B vaccination. I understand that I must receive at least 3 intramuscular doses of vaccine in the arm over a 6-month period to confer immunity. However, as with all medical treatment, there is no guarantee that I will become immune or that I will not experience an adverse side effect from the vaccine.
I do understand that anyone with a known allergy to yeast should not accept this vaccine. Hepatitis B vaccine will be made available at no charge to employees having occupational blood exposure.
I have had an opportunity to ask questions, and all my questions have been answered to my satisfaction.
I believe that I have adequate upon which to base an informed consent. I understand that participation is voluntary, and my consent or refusal of vaccination does not waive any rights under my employment contracts. In addition, I can withdraw from the vaccination regimen at any time.
I desire that my employer provide the required three (3) doses of Hepatitis B Vaccine.