Exact wording of hepatitis B vaccine declination form

NOTICE: This is an OSHA Archive Document, and may no longer represent OSHA Policy. It is presented here as historical content, for research and review purposes only.

January 21, 1998

Mr. Richard F. Fabbro, C.S.P.
Longview Fibre Company
Main Office and Mills
[Recipient address omitted]
Dear Mr. Fabbro:

This is in response to your letter dated October 20. In your letter you provide information concerning a recent compliance inspection conducted at your corrugated container plant in Milwaukee. The inspection conducted by the Occupational Safety and Health Administration (OSHA), included a review of the company's declination form that is required in the mandatory Appendix A of the Bloodborne Pathogens standard, 29 CFR 1910.1030. The question that you have asked concerns whether or not OSHA requires that the declination form contain the exact wording as it appears in Appendix A.

The purpose of requiring employees to sign a declination form is to encourage greater participation in the vaccination program. The requirement to use the wording as it appears in Appendix A ensures that the exact same message is delivered to each employee in all workplaces. The employee is reminded that they remain at risk of acquiring Hepatitis B. OSHA's Instruction CPL 2-2.44C, an instruction that establishes policy with regards to the Bloodborne Pathogens standard states that, "the declination form statement used by the employer must contain the same language as that found in Appendix A--no words may be added or subtracted." This same policy has been re-stated in letters to the public and reproduced in the Bloodborne Pathogens Interpretive Quips. This requirement provides protection against using the declination form for any other purpose than what it was intended. Additional wording may be harmless in some cases, but in others the message may provide a disincentive to employees and discourage participation in the vaccine program.

I hope this addresses you concerns. Thank you for your interest in safety and health. If you have further questions, please feel free to call Wanda Bissell of my staff at (202) 219-8036 Ext. 41.

Sincerely,

John B. Miles Jr
Director
Directorate of Compliance Programs