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In declining an influenza vaccination for non medical reasons I am aware that The vaccine does not cause the flu. Name Print Last 4 SSN DOB School/lnstitution Semester 2015 2016 Student Influenza Declination Form I understand that I am at risk for exposure to the influenza virus and may be at risk for developing influenza infection. I have received read and understand information about the risks and benefits of the vaccine. Influenza strains change every year and an immunization received in a...
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How to fill out 20152016 flu declination form
How to fill out 20152016 flu declination form
01
Obtain the 20152016 flu declination form from your employer.
02
Read through the form to understand the information required.
03
Fill in your personal details accurately, including your name, address, and contact information.
04
Provide information about your medical history and any allergies you may have.
05
Indicate whether you have received the flu vaccine in the past or plan to receive it this year.
06
Sign and date the form.
07
Submit the completed form to the designated person or department at your workplace.
Who needs 20152016 flu declination form?
01
Employees who are required to take the flu declination form for the year 20152016.
02
Individuals who have not received the flu vaccine in the past or plan to receive it this year.
03
People with medical conditions or allergies who need to notify their employers about their health status.
04
Any employees who are part of a workplace where flu prevention measures are mandatory.
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