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Hepatitis B Vaccine Offers and Declinations

OSHA's Bloodborne Pathogens standard, 29 CFR 1910.1030, requires employers to offer the hepatitis B vaccine to workers who may be exposed to blood on the job. Workers may say no, but they must sign a declination using OSHA's required statement. For staff placed by a staffing agency, OSHA puts the vaccine duty mainly on the agency. This guide explains the rules and the records to keep.

Updated October 3, 2026 · Checked against official CDC and OSHA sources

Who the rule covers

The standard applies to all occupational exposure to blood or other potentially infectious materials (1910.1030(a)). Nurses, CNAs, and many allied health workers have this kind of exposure.

OSHA's enforcement directive for this standard (CPL 02-02-069) says the vaccine duty covers all workers with occupational exposure, no matter how often the exposure happens. It says part-time and temporary employees are included.

Offering the vaccine: cost and timing

The employer must make the hepatitis B vaccine and vaccination series available to all workers with occupational exposure (1910.1030(f)(1)(i)).

It must be offered at no cost to the worker, at a reasonable time and place, and by or under the supervision of a licensed healthcare professional (1910.1030(f)(1)(ii)).

Timing matters. The vaccine must be made available after the worker gets training about the vaccine, and within 10 working days of initial assignment (1910.1030(f)(2)(i)). OSHA's directive says "made available" includes the healthcare professional's evaluation and arranging for the first dose to begin within those 10 days.

The employer may not require the worker to take part in a prescreening program before getting the vaccine (1910.1030(f)(2)(ii)).

• No cost to the worker.
• Training about the vaccine first.
• Vaccine made available within 10 working days of initial assignment.
• No required antibody prescreening.

When the vaccine does not have to be offered

Under 1910.1030(f)(2)(i), the vaccine does not have to be offered in three cases. OSHA's directive says that if the employer relies on one of these, it must be documented in the worker's medical record.

• The worker has already received the complete hepatitis B vaccination series.
• Antibody testing has shown the worker is immune.
• The vaccine is contraindicated for medical reasons.

The declination form

A worker may decline. OSHA's directive says the words "made available" mean the worker has the option to say no. But the employer must make sure a worker who declines signs the statement in Appendix A of the standard (1910.1030(f)(2)(iv)).

The Appendix A statement reads: "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 been given the opportunity to be vaccinated with hepatitis B vaccine, at no charge to myself. However, I decline hepatitis B vaccination at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring hepatitis B, a serious disease. If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with hepatitis B vaccine, I can receive the vaccination series at no charge to me."

The safest path is to use the Appendix A words exactly. OSHA's directive says a form that gives the same information in different words is treated as a de minimis violation. Any added words should only be there to help the worker understand. A form must not add language that discourages the vaccine or adds liability concerns. If it asks for confidential medical information, OSHA says a confidentiality citation should be considered.

• Use the Appendix A wording.
• Do not add a liability waiver or anything that discourages vaccination.
• Do not ask for private medical details on the form.
• Keep the signed and dated form in the worker's file.

If the worker changes their mind

A declination is not final. If a worker first declines but later decides to accept the vaccine while still covered by the standard, the employer must make the vaccine available at that time (1910.1030(f)(2)(iii)). OSHA's directive says signing the declination does not relieve the employer of this duty.

Separately, if the U.S. Public Health Service ever recommends routine booster doses, those must also be made available (1910.1030(f)(2)(v)).

Training and records

Training must be free, during working hours, at the time of initial assignment to tasks with possible exposure, and at least once a year after that (1910.1030(g)(2)(i)-(ii)). OSHA's directive says the yearly refresher must be within one year of the original training.

Each worker with occupational exposure must have a medical record (1910.1030(h)(1)). It must include the worker's hepatitis B vaccination status, with the dates of all doses and any medical records about their ability to get the vaccine. Medical records must be kept confidential. They may not be shared without the worker's written consent, except as the standard or law requires.

Medical records must be kept for at least the length of employment plus 30 years (1910.1030(h)(1)(iv)). Training records must be kept for 3 years from the date of training (1910.1030(h)(2)(ii)).

• Medical record: name, hepatitis B vaccination status and dates, and records about ability to be vaccinated.
• Medical record: post-exposure exam and test results, if any.
• Training record: dates, content summary, trainer names and qualifications, and attendee names and job titles.
• Keep medical records separate and confidential.

Staffing agency vs. facility: who does what

OSHA's directive speaks directly to personnel services firms that place medical staff in hospitals and other healthcare facilities. When the facility supervises the workers day to day, OSHA says the firm should be cited for bloodborne pathogens violations only in certain areas. These include hepatitis B vaccinations, post-exposure evaluation and follow-up, recordkeeping, and generic training.

OSHA's Temporary Worker Initiative Bulletin No. 6 says the same thing in plain terms. The staffing agency is responsible for generic bloodborne pathogen training, for making sure temporary workers get the required vaccinations and follow-up, for post-exposure evaluation and follow-up, and for keeping medical and training records.

The facility generally handles the written exposure control plan, site-specific training, and protective equipment. OSHA says the host employer must also take reasonable measures to make sure the staffing agency has met its hepatitis B, follow-up, records, and training duties. That is why facilities ask your agency for proof.

The two employers may divide duties in their contract. But OSHA says neither employer may avoid its ultimate responsibilities under the OSH Act by shifting them to the other.

Common questions

Sources

• OSHA 29 CFR 1910.1030 Bloodborne Pathogens
• OSHA 29 CFR 1910.1030 Appendix A: Hepatitis B Vaccine Declination (Mandatory)
• OSHA Directive CPL 02-02-069: Enforcement Procedures for Occupational Exposure to Bloodborne Pathogens
• OSHA Temporary Worker Initiative Bulletin No. 6: Bloodborne Pathogens (OSHA 3888)
• OSHA: Protecting Temporary Workers