Vaccinations
Forms
Hepatitis B Vaccination Record
(AIP2090)
Vaccination Report of Healthcare Provider
(AIP2100)
Employee Declination of Hepatitis B Vaccine
(AIP2110)
Instructions
All employees with occupational exposure to blood or other potentially infectious materials are at risk of contracting hepatitis B, which is a serious and life-threatening disease. However, the hepatitis B infection is preventable by vaccination. Accordingly, California’s Bloodborne Pathogen Standard requires employers to provide the hepatitis B vaccine to all employees with occupational exposure within 10 working days of their initial assignment. Employers must also provide follow-up serological testing to confirm that the vaccination was effective. (8 C.C.R. § 5193(f).)
The employer must ensure that the licensed healthcare professional administering the vaccination (1) is provided a copy of California’s Bloodborne Pathogen Standard, and (2) provides the employee and employer with a specific report on the results of the vaccination. (Purchase the Vaccination Report of Healthcare Provider using the button above.)
California’s Bloodborne Pathogen Standard requires employers to maintain an accurate copy of each employee’s hepatitis B vaccination status, including the dates of each of the three doses required for the full series. (Purchase the Hepatitis B Vaccination Record using the button above.) These records are important in treating any employees who later become involved in an exposure incident. Employees are permitted to decline the hepatitis vaccination, but are legally required to sign a specific waiver form. (Purchase the Employee Declination of Hepatitis B Vaccination using the button above.)
