{"id":37393,"date":"2022-03-25T15:03:09","date_gmt":"2022-03-25T20:03:09","guid":{"rendered":"https:\/\/www.tamus.edu\/safety\/?page_id=37393"},"modified":"2025-10-07T14:53:54","modified_gmt":"2025-10-07T19:53:54","slug":"hepatitis-b-vaccination-form-2","status":"publish","type":"page","link":"https:\/\/www.tamus.edu\/safety\/health-safety\/hepatitis-b-vaccination-form-2\/","title":{"rendered":"Hepatitis B Vaccination Form"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; background_color=&#8221;#d1d1d1&#8243; background_image=&#8221;https:\/\/www.tamus.edu\/safety\/wp-content\/uploads\/sites\/152\/2021\/06\/Vaccine2.png&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row use_custom_gutter=&#8221;on&#8221; _builder_version=&#8221;4.16&#8243; width=&#8221;66.8%&#8221; width_tablet=&#8221;100%&#8221; width_phone=&#8221;100%&#8221; width_last_edited=&#8221;on|desktop&#8221; max_width=&#8221;2560px&#8221; max_width_tablet=&#8221;&#8221; 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Upon completion of this form, you will be contacted by a Biosafety or Environmental Health and Safety staff member with additional instructions for receiving the vaccination series. If you DO NOT want to receive the Hepatitis B Vaccination series, do not complete this form. Please direct additional questions or concerns to your System Member Safety Office (https:\/\/www.tamus.edu\/business\/safety\/system-member-safety-offices\/).<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_18'  action='\/safety\/wp-json\/wp\/v2\/pages\/37393' data-formid='18' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_18' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_18_13\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name 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Service<\/option><option value='E' >Texas A&amp;M Engineering Experiment Station<\/option><option value='F' >Texas A&amp;M Forest Service<\/option><option value='G' >Texas A&amp;M University at Galveston<\/option><option value='H' >Texas A&amp;M University Health Science Center<\/option><option value='I' >Texas A&amp;M University-Corpus Christi<\/option><option value='J' >Texas A&amp;M University-Kingsville<\/option><option value='K' >Texas A&amp;M University-Central Texas<\/option><option value='L' >Texas A&amp;M International University<\/option><option value='M' >Texas A&amp;M University<\/option><option value='N' >Texas A&amp;M University-Texarkana<\/option><option value='O' >Texas A&amp;M University-San Antonio<\/option><option value='P' >Prairie View A&amp;M University<\/option><option value='R' >Texas A&amp;M University-Commerce<\/option><option value='S' >Texas A&amp;M University System Offices<\/option><option value='T' >Tarleton State University<\/option><option value='V' >Texas A&amp;M Veterinary Medical Diagnostic Laboratory<\/option><option value='W' >West Texas A&amp;M University<\/option><option value='X' >Texas A&amp;M AgriLife Extension<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_18_2'>Select your employing member's workstation.<\/div><\/li><li id=\"field_18_4\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Hepatitis B Vaccination<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_18_4'>You have the right to request or decline the hepatitis B (HBV) vaccination series. You should have already received training on the risks and prevention of occupational exposure to bloodborn pathogens, including HBV, and had an opportunity to ask questions. If you have not completed the training, please do so before filling out this form.<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_18_4'>\n\t\t\t<li class='gchoice gchoice_18_4_0'>\n\t\t\t\t<input name='input_4' type='radio' value='Accept the Vaccination'  id='choice_18_4_0'    \/>\n\t\t\t\t<label for='choice_18_4_0' id='label_18_4_0' class='gform-field-label gform-field-label--type-inline'>Accept the Vaccination<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_18_7\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">REQUEST TO RECEIVE HEPATITIS B VACCINE<\/h2><div class='gsection_description' id='gfield_description_18_7'>I have been informed of the biological hazards that exist in my workplace, and I understand the risks of exposure to blood or other potentially infectious materials involved with my job. 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