Get the free 2013-2014 Influenza Vaccination Attestation/Declination Form - ohsu

2013-2014 Influenza Vaccination Attestation/Declination Form OSU recommends I receive influenza vaccination to protect the patients OSU serves. I attest that I have already received the influenza

How to fill out 2013-2014 influenza vaccination attestationdeclination

How to fill out 2013-2014 influenza vaccination attestation/declination:

1. Obtain the form: The first step to filling out the 2013-2014 influenza vaccination attestation/declination form is to acquire the form itself. Check with your employer or the organization requiring the form to see where it can be obtained.
2. Read the instructions: Before you start filling out the form, carefully read the instructions provided. This will help ensure that you understand the purpose and process of completing the attestation/declination.
3. Provide personal information: The form will typically require you to provide personal information such as your full name, date of birth, and contact details. Fill in these details accurately and legibly.
4. Indicate your vaccination status: The main purpose of this form is to declare your vaccination status for the 2013-2014 influenza season. If you have received the influenza vaccine, mark the appropriate box indicating that you have been vaccinated.
5. Fill out the declination section (if applicable): If you have chosen not to receive the influenza vaccine, you will need to complete the declination section of the form. This section may require you to provide a reason for declining the vaccination.
6. Check for any additional information: Some forms may have additional sections or information to be filled out, such as questions about previous vaccination history or medical conditions. Verify if any such sections exist on the form and complete them as necessary.
7. Review the form: Before submitting the form, take a moment to review all the information you have provided. Ensure that there are no errors or omissions, and make any necessary corrections.
8. Sign and date the form: Once you are satisfied with the accuracy of the information, sign and date the form. This serves as your confirmation that the details you have provided are true and accurate.

Who needs 2013-2014 influenza vaccination attestation/declination?

1. Healthcare workers: In many healthcare settings, it is mandatory for healthcare workers, including physicians, nurses, and support staff, to complete the attestation/declination form to determine their vaccination status. This helps protect vulnerable patients from being exposed to the influenza virus.
2. Employees in high-risk industries: Some employers in high-risk industries, such as long-term care facilities, prisons, and schools, may require their employees to complete the attestation/declination form. This is done to mitigate the risk of influenza outbreaks among populations that are more susceptible to severe illness.
3. Individuals partaking in certain activities: Depending on the organization or event, individuals participating in specific activities like youth camps, sports events, or international travel may be required to fill out the form. These measures aim to prevent the spread of the influenza virus among participants and the larger community.

Note: The specific requirement for attestation/declination forms may vary depending on local regulations, policies, and the prevailing influenza situation. It is always advised to follow the guidelines provided by your employer or the relevant authorities.

For pdfFiller’s FAQs

What is influenza vaccination attestationdeclination form?

Influenza vaccination attestation/declination form is a document where individuals can state whether they have received the influenza vaccine or choose to decline it.

Who is required to file influenza vaccination attestationdeclination form?

Employees or individuals in certain organizations or industries may be required to file the influenza vaccination attestation/declination form.

How to fill out influenza vaccination attestationdeclination form?

To fill out the form, individuals need to indicate whether they have received the influenza vaccine or decline it, and provide any requested information or documentation.

What is the purpose of influenza vaccination attestationdeclination form?

The purpose of the form is to track and record influenza vaccination status for individuals in a specified group or setting.

What information must be reported on influenza vaccination attestationdeclination form?

The form may require basic personal information, vaccination status, and date of vaccination or declination.

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