• Employers can’t force workers to undergo screening for antibodies or vaccination, or to allow the employer access to their test results.
• Workers can decline hepatitis B vaccination but must be given appropriate training about it and sign OSHA’s statement of declination.

Worker consent and confidentiality in regard to hepatitis B vaccination are crucial. Employees cannot be required to be screened for HBV antibodies before or after vaccination, or to release test results to their employers. They can choose not to receive the hepatitis B vaccine.

Consent forms and waivers

Section 1910.1030 does not refer to consent forms for employees accepting the vaccine, so they’re not required. According to the Occupational Safety and Health Administration (OSHA), medical informed consent forms are acceptable, unless they require employees to release test results to their employers or they exaggerate the hazards of the vaccine. Any waiver of liability for any harm caused by the vaccine also violates the regulation.

Pre- and post-vaccination testing

According to OSHA, an employer cannot require an employee to be pre-screened for hepatitis B virus antibodies. However, pre-screening can be made available at no cost to the employee. If the antibody testing reveals that the employee is immune, the employer doesn’t have to provide vaccination to that employee. If an employee declines the pre-screening, then the employer must make the vaccination available.

An employer also cannot require post-vaccination testing unless the Centers for Disease Control and Prevention (CDC) call for it. CDC guidelines do call for a post-vaccination titer for certain employees who have ongoing contact with patients or blood and who are at ongoing risk of percutaneous (through the skin) injuries.

All laboratory tests must be free of charge to the employee and conducted by an accredited lab. The healthcare professional must provide a written opinion to the employer as to whether hepatitis B vaccination is needed and if the employee has received it.

Vaccination declination statement

Any employee with occupational exposure who chooses not to receive the hepatitis B vaccine must sign OSHA’s statement of declination of hepatitis B vaccination. Before signing, the employee must be given appropriate training regarding the following:

• Hepatitis B epidemiology, symptoms, and modes of transmission;
• Hepatitis B vaccination, including the effectiveness, safety, method of administration, and benefits of being vaccinated; and
• The availability of the hepatitis B vaccine and vaccination free of charge to the employee with occupational exposure.

The statement is not a waiver; employees can request and receive the hepatitis B vaccination at a later date, provided they still have occupational exposure.

Signing the statement of declination confirms that the employee is aware of the risk of hepatitis B and was given the chance to be vaccinated, but is declining it with the understanding that a free vaccination will be available at a later date if the employee still has occupational exposure.

Employers must use the declination form as provided by OSHA. Any additions to the form language should be made for the sole purpose of improving employee comprehension. Using a form that conveys the same information, but with different words, may be considered a de minimis (no penalty) violation. Employers must not add language that would discourage employee acceptance of the vaccine or add liability concerns. If an employer adds information that requires the employee to provide confidential medical information, either on the declination form or on a separate form, an OSHA citation may be issued.