Get Sample Hep B Declination Form

Filling out the Sample Hep B Declination Form online is an essential step for individuals who choose to decline the hepatitis B vaccination offered by their employer. This guide provides clear and detailed instructions to help you complete the form accurately and confidently.

Follow the steps to complete the form correctly.

1. Click the ‘Get Form’ button to access the form and open it in a suitable editing tool.
2. In the first section, read the declaration statement carefully. This statement outlines your understanding of the risks associated with declining the hepatitis B vaccination.
3. Next, fill in the date in the designated field. This date should reflect when you are completing the form.
4. Proceed to enter your printed name in the section labeled 'Employee’s printed name'. Ensure that your name is legible and matches the ID you may provide.
5. Sign your name in the 'Employee’s signature' section. This signature confirms your decision to decline the vaccination.
6. Next, the employer representative will need to enter their printed name in the 'Employer representative’s printed name' field.
7. The employer representative must also sign the form in the 'Employer representative’s signature' section, confirming they acknowledge your declination.
8. Review all entries for accuracy. Once everything is correct, you can save changes, download the form, print a physical copy, or share it as needed.

Begin filling out the Sample Hep B Declination Form online today to ensure your choice is properly documented.