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Addendum L: OSHA Hepatitis B Declination Statement When the waiver is signed, no words may be added or deleted to the exemption. IT MUST BE EXACTLY AS WORDED BELOW. Copy the form, print, sign and
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How to fill out hep b declination form

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How to fill out Addendum L: OSHA Hepatitis B Declination Statement

01
Begin by obtaining a copy of Addendum L: OSHA Hepatitis B Declination Statement.
02
Read the introductory section to understand the purpose of the form.
03
Identify your name and job title clearly in the designated fields.
04
Review the information regarding the Hepatitis B vaccination and its benefits.
05
Indicate your decision regarding the vaccination by checking the appropriate box (accept or decline).
06
If declining, provide a brief explanation for your decision if required.
07
Sign and date the form at the bottom to confirm your choice.
08
Submit the completed Addendum L to your supervisor or the appropriate department.

Who needs Addendum L: OSHA Hepatitis B Declination Statement?

01
Employees who are at risk of occupational exposure to blood or other potentially infectious materials.
02
Healthcare workers and employees in related fields who may be exposed to Hepatitis B in their jobs.
03
Any worker who is offered the Hepatitis B vaccination as part of workplace safety protocols.
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People Also Ask about

If an employee declines the hepatitis B vaccination, the employer must ensure that the employee signs a hepatitis B vaccine declination.
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.
The hepatitis B vaccine is recommended for all infants, all children or adolescents younger than 19 years of age who have not been vaccinated, all adults age 19 through 59 years, and adults age 60 years or older with risk factors for hepatitis B infection.
An employee has a right to refuse the vaccination. If you do, however, you should realize that without the hepatitis B immunization three-injection series or evidence of immunity from previous viral infection, you remain at risk for acquiring hepatitis B virus (HBV) infection.
A hepatitis B declination form is a form your employer may give you to offer you the hepatitis B vaccine option due to the occupational risk of exposure to the virus. You can sign to either accept or decline the vaccination.
Employees may decline to be vaccinated with hepatitis B vaccine, but must sign a declination form. All HCP who are at risk for occupational blood or body fluid exposure should have documentation of 3 doses of hepatitis B vaccine (or a signed declination form).

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Addendum L: OSHA Hepatitis B Declination Statement is a document required by the Occupational Safety and Health Administration (OSHA) that allows employees to formally decline the hepatitis B vaccination offered by their employer.
Employees who are at risk of occupational exposure to blood or other potentially infectious materials and choose to decline the hepatitis B vaccination are required to file Addendum L.
To fill out Addendum L, the employee must complete personal information such as name, position, and date. They must also indicate their decision to decline the vaccination and provide a signature to acknowledge their understanding of the risks.
The purpose of Addendum L is to protect both the employee and employer by documenting the employee's decision to decline the hepatitis B vaccination, ensuring that the employee is aware of the risks involved.
The information that must be reported on Addendum L includes the employee's name, job title, date of decision, a statement of declination, and the employee's signature confirming their choice.
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Immunization Requirements - Tufts University School of Dental ...
Hepatitis B: Three doses of hepatitis B vaccine and positive surface antibody titer ... of vaccine within five years prior to start date or completion of State Waiver Form. ... on the Student Advisory & Health Administration Office (SAHA) website.
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