I understand that due to my occupational exposure to blood or other potentially infectious materials that I may be at risk of being infected by bloodborne pathogens, including Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV). This is to certify that I have been informed about the symptoms and the hazards associated with these viruses, as well as the modes of transmission of bloodborne pathogens. I have been given the opportunity to be vaccinated with Hepatitis B vaccine. In addition, I have received information regarding the Hepatitis B (HBV) vaccine. Based on the training ] received. I am making an informed decision to accept the Hepatitis B (HBV) vaccine.
I understand that due to my occupational exposure to blood or other potentially infectious materials that 1 may be at risk of acquiring Hepatitis B Virus (HBV) infection. I have been given the opportunity to be vaccinated with Hepatitis vaccine. 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. If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with Hepatitis B vaccine. I can do so at any time.
