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California Code of Regulations (Last Updated: August 6, 2014) |
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Title 8. Industrial Relations |
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Division 1. Department of Industrial Relations |
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Chapter 4. Division of Industrial Safety |
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Subchapter 7. General Industry Safety Orders |
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Group 16. Control of Hazardous Substances |
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Article 109. Hazardous Substances and Processes |
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Aerosol Transmissible Diseases |
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Appendix c2. - Seasonal Influenza Vaccination Declination Statement (Mandatory) |
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The employer shall ensure that employees who decline to accept the seasonal influenza vaccination offered by the employer sign and date the following statement as required by subsection (h)(10): I understand that due to my occupational exposure to aerosol transmissible diseases, I may be at risk of acquiring seasonal influenza. I have been given the opportunity to be vaccinated against this infection at no charge to me. However, I decline this vaccination at this time. I understand that by declining this vaccine, I continue to be at increased risk of acquiring influenza. If, during the season for which the CDC recommends administration of the influenza vaccine, I continue to have occupational exposure to aerosol transmissible diseases and want to be vaccinated, I can receive the vaccination at no charge to me.
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