Get Va Form 10 9050 Appendix B

Filling out the Va Form 10 9050 Appendix B is an essential step for health care personnel to document their influenza vaccination status. This guide provides clear, step-by-step instructions to help users complete the form online with ease.

Follow the steps to complete the Va Form 10 9050 Appendix B online.

1. Press the ‘Get Form’ button to access the form and open it in the online editor.
2. Identify your status as a VA employee, student, volunteer, or trainee by selecting the appropriate option.
3. Indicate whether you have received the seasonal influenza vaccine by checking the respective box and ensure that the required documentation is attached.
4. If you are declining to receive the vaccine, select one of the provided reasons that best describes your decision.
5. If selecting 'another reason,' provide a brief explanation in the space provided.
6. Acknowledge your understanding of VHA policy regarding vaccination requirements and potential consequences of non-compliance by checking the acknowledgment box.
7. Sign the form by adding your signature in the designated space.
8. Enter the date you are completing the form in the specified area.
9. Print your name clearly in the designated space for printed name.
10. Fill in your last four digits of your social security number, department or service, and supervisor's name.
11. After filling in the form, you can save your changes, download, print, or share the completed form as necessary.

Complete your forms online to ensure a smooth documentation process.