Free Hepatitis B Vaccination Declination Form

Any organization that is exposed to blood and bloodborne pathogens must give employees the option to receive the Hepatitis B vaccine at no cost. Our Bloodborne Pathogen Exposure Control Program address this requirement directly. 

We also house all of your compliance records and requirements in a customized online folder. This meets OSHA's recordkeeping requirements, "OSHA requires us to keep records of individuals who decline the vaccine, and we may require you to complete a 'Declination Statement.' We will also keep confidential records of individuals electing the vaccine." OSHA Source:

• Part Number:


• Part Title:

Occupational Safety and Health Standards

• Subpart:


• Subpart Title:

Toxic and Hazardous Substances

• Standard Number

1910.1030 App A 

• Title:

Hepatitis B Vaccine Declination (Mandatory)

• GPO Source:



Fill out the following form to get your Free Hepatitis B Vaccination Declination Form.