Get Hepatitis B Vaccine Form - Environmental Health And Safety

This guide provides a professional and supportive overview on how to fill out the hepatitis B vaccine form required by the Environmental Health and Safety department. It breaks down each section of the form, offering clear and instructive guidance for users of all backgrounds.

Follow the steps to complete the hepatitis B vaccine form successfully.

1. Click the 'Get Form' button to access the hepatitis B vaccine form and open it in your preferred editing tool.
2. Complete the personal information section. Enter your full name (last, first, middle initial), job title, student identification number if applicable, email, and daytime phone number.
3. Fill in the department you work in, your birthdate (in the specified format), and employee identification number.
4. Indicate your work location by selecting from the options provided, which may include Seattle Campus, Harborview, South Lake Union, or specify another location.
5. Enter the name of your supervisor or principal investigator (PI) in the provided field.
6. Choose one of the three sections regarding the hepatitis B vaccine: Acknowledging your interest in receiving the vaccine, Declining the vaccine due to previous immunizations, or an outright Declination Statement for the vaccine.
7. If you choose to receive the vaccine, provide any comments and ensure to sign and date the form.
8. If you have received the vaccine previously, list the immunization dates and submit your documentation as required in that section.
9. Ensure any comments related to declining the vaccine are noted. Provide your signature and date before submitting.
10. After filling out the form, save your changes. You can download, print, or share the completed form as needed, and ensure it is submitted to the UW Employee Health Center.

Complete your hepatitis B vaccine form online today to ensure your safety and compliance.