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This document serves as a declination statement for employees at the University of Arkansas at Little Rock who have the option to decline the Hepatitis B vaccination due to occupational exposure to
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How to fill out declination statement - bloodborne
How to fill out Declination Statement - Bloodborne Pathogen/Exposure Control Plan
01
Obtain a copy of the Declination Statement form.
02
Read the instructions carefully to understand the significance of the form.
03
Provide your full name and any required identifying information.
04
Indicate your reason for declining the Bloodborne Pathogen vaccinations or procedures.
05
Sign and date the form to acknowledge your understanding of the risks associated with declining.
06
Submit the completed form to your supervisor or the designated safety officer.
Who needs Declination Statement - Bloodborne Pathogen/Exposure Control Plan?
01
Employees who may be exposed to bloodborne pathogens in their workplace.
02
Healthcare workers, laboratory personnel, or first responders.
03
Individuals working in environments with a potential risk of bloodborne exposure.
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People Also Ask about
What is the OSHA standard for Hep B?
When the employer cannot obtain records or employees are uncertain about whether they were vaccinated, the hepatitis B vaccine must be made available, unless previous antibody testing has revealed that the employee is immune or the vaccine is contraindicated for medical reasons [29 CFR 1910.1030(f)(2)(i)].
What are the five steps of an exposure control plan?
Contact the Office of Risk Management for questions. Step 1: Required Personal Protective Equipment. Step 2: Equipment. Step 3: Decontamination Procedures. Step 4: Disposal. Step 5: Decontaminate Re-useable Equipment. Step 6: Wash Your Hands.
What is the OSHA statement for hepatitis B declination?
I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring hepatitis B virus (HBV) infection.
What must an employee do if they decline to be vaccinated for hepatitis B?
If an employee declines the hepatitis B vaccination, the employer must ensure that the employee signs a hepatitis B vaccine declination.
Can an employee decline the hepatitis B vaccine?
Employees who decline the vaccine should sign a declination form that includes information explaining that they are at an increased risk for getting hepatitis B if exposed to infected blood.
What is the exposure control plan for blood-borne pathogens?
An Exposure Control Plan is the focal point of any bloodborne pathogens exposure prevention program. It details in writing your plan for reducing exposures to blood and explains what steps to take if an exposure occurs. The plan specifies all steps taken your facility to protect your workers.
What is a declination waiver for Hep B?
DECLINATION: I understand that due to my occupational exposure to blood or other poten tially infectious materials that I may be at risk of acquiring Hepatitis B Virus (HBV) infection. I have been given the opportunity to be vaccinated with Hepatitis B vaccine. However, I decline Hepatitis B vaccination at this time.
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What is Declination Statement - Bloodborne Pathogen/Exposure Control Plan?
The Declination Statement is a document that allows employees to formally decline receiving the hepatitis B vaccination as part of the Bloodborne Pathogen/Exposure Control Plan. It outlines the potential risks associated with bloodborne pathogens and provides employees the choice to opt out of vaccination.
Who is required to file Declination Statement - Bloodborne Pathogen/Exposure Control Plan?
Employees who are potentially exposed to bloodborne pathogens and are offered the hepatitis B vaccination as part of the Exposure Control Plan are required to file a Declination Statement if they choose not to receive the vaccination.
How to fill out Declination Statement - Bloodborne Pathogen/Exposure Control Plan?
To fill out the Declination Statement, the employee must provide their name, date, and a signature indicating their decision not to receive the hepatitis B vaccination. They may also be required to acknowledge that they understand the risks associated with declining the vaccine.
What is the purpose of Declination Statement - Bloodborne Pathogen/Exposure Control Plan?
The purpose of the Declination Statement is to document an employee's decision to decline the hepatitis B vaccination and to ensure that the employer complies with OSHA regulations regarding employee health and safety in the workplace.
What information must be reported on Declination Statement - Bloodborne Pathogen/Exposure Control Plan?
The information that must be reported on the Declination Statement includes the employee's name, date, a clear statement of declination, and the employee's signature acknowledging their decision and understanding of the associated risks.
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