Montana 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

Although the majority of persons vaccinated against hepatitis B successfully respond to vaccination, an estimated 5-15% of persons may not respond due to older age, obesity, smoking, and other chronic illness.

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.

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.

The main risk of the baby not getting the vaccine is that they may contract the hepatitis B virus. Hepatitis B primarily attacks the liver, causing inflammation that can damage this organ over time. An acute infection lasts for less than 6 months and may cause no symptoms in some people.

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.

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.

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.

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.

All babies should get the first shot of hepatitis B vaccine within 24 hours of birth. This shot reduces the risk of your baby getting the disease from you or family members who may not know they are infected with hepatitis B.

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Montana Hepatitis B Vaccine Acceptance Declination Form