Due to the possibility of your exposure to blood-borne pathogens, you are entitled to Hepatitis B virus (HBV) anybody testing and/or vaccinations. Though this immunization is not mandatory, it is strongly recommended. Please check with your primary physician if you have been immunized and if a buster is required.

I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at acquiring or transmitting Hepatitis B virus (HBV) infection, 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 may do so.

Reference: Appendix A, 29 Code of Federal Regulations 1910,103 Occupational e to Bloodborne Pathogens. Occupational Safety and Health Act.