Florida Hepatitis B Vaccine Acceptance Declination Form

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US-0509BG
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The Occupational Safety and Health Act was passed to insure that employees have a safe place at which to work. The Occupational Safety and Health Administration, known as OSHA, was formed to enforce this Act. Completion of this form is a requirement of O

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FAQ

Approximately 5-10% of vaccinees are defined as non-responders, i.e. they do not develop a protective anti-HBs titer after completing a full primary series of the hepatitis B vaccine (58).

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.

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.

Employers must ensure that workers who decline vaccination sign a declination form. The purpose of this is to encourage greater participation in the vaccination program by stating that a worker declin- ing the vaccination remains at risk of acquiring hepatitis B.

If an employee initially declines the vaccination, and then decides to have it, the employer must pay for the initial vaccination series and post-vaccination testing, and second vaccination series and testing, if necessary.

It is also possible that a person who does not respond to the vaccine may already be infected with hepatitis B. Therefore, testing for the presence of the hepatitis B virus (hepatitis B surface antigen or HBsAg) is recommended before diagnosing a person as a "vaccine non-responder."

People who are non-responders after receiving the booster should be tested for hepatitis B virus infection. If negative, they are recommended to receive 2 more doses of hepatitis B vaccine 1 month apart. Count the 4th booster dose as the 1st of the 3 repeat doses.

A hepatitis B vaccine non-responder" refers to a person who does not develop protective surface antibodies after completing two full series of the hepatitis B vaccine and for whom an acute or chronic hepatitis B infection has been ruled out.

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Florida Hepatitis B Vaccine Acceptance Declination Form