Appendix A - Hepatitis B Vaccine Declination (Mandatory)

Regulations (Standards - 29 CFR)
Hepatitis B Vaccine Declination (Mandatory) - 1910.1030 App A
1910 Occupational Safety and Health Standards
Toxic and Hazardous Substances
1910.1030 App A
Hepatitis B Vaccine Declination (Mandatory)

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.
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.
[56 FR 64004, Dec. 06, 1991, as amended at 57 FR 12717, April 13, 1992; 57 FR 29206,
July 1, 1992; 61 FR 5507, Feb. 13, 1996]