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.
I have read and understand the health risks involved with Hepatitis B, however, I voluntarily decline Hepatitis B vaccination at this time.
I fully understand the risk of its transmission, and have full knowledge of its effects on the human body. I understand that by declining this vaccine I continue to be at risk of acquiring Hepatitis B, a serious disease.