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HEPATITIS B VACCINATION AND ANTIBODY TESTINGDirections: The spaces below are to be completed by the employer. ________________________ makes available the Hepatitis B vaccine series to all coveredemployees (identified in this Exposure Control Plan) who are at riskof occupational exposure, at no cost to them after training and within10 days of initial employment.Please note: Vaccination is encouraged unless (1) documentation exists thatthe employee has previously received the vaccine series, (2) antibody testingreveals that the employee has previously received the series or (3) medicalevaluation shows that vaccination is contraindicated. ________________________ ensures that one or two months following the Hepatitis B vaccinationseries all employees who are at risk of occupational exposure will betested for HBV surface antibody. ________________________ ensures that vaccination is performed by or under the supervisionof a licensed physician, or by or under the supervision of anotherlicensed health care professional.Name/address of licensed physician or licensed healthcare professional ________________________ has determined that all laboratory testing is conducted by anaccredited laboratory. Evidence of such accreditation is on file.Please note: It is the employer’s responsibility to assure that all laboratorytests be conducted by an accredited laboratory. Employer documentation(e.g., certification to verify this accreditation, such as CDC or College ofAmerican Pathologists or equivalent state agency, which participates in arecognized quality assurance program) is required. ________________________ ensures that employees who decline the Hepatitis B vaccination havesigned the OSHA required waiver indicating their refusal found onpage 24 of this Exposure Control Plan. ________________________ ensures that if an employee initially declines the Hepatitis Bvaccination, but at a later date, while still covered under theBloodborne Pathogens Standard, decides to accept thevaccination, the vaccination shall then be made available at no costto the employee.EMPLOYER PAGEATTENTIONOSHA EXPOSURE CONTROL PLAN…a member benefit from the WDA 22
HEPATITIS B VACCINATION AND ANTIBODY TESTING CONTINUED ________________________ will file a statement (from the health care professional responsible forvaccination) which states whether the employee can or cannot bevaccinated for whatever reason and that, where appropriate, thevaccine has been administered. This is called the “HealthcareProfessional’s Written Opinion”. ________________________ will assure that the vaccination program is instituted and performed.Directions: The space below is to be filled in with the name of the person conducting the training. ________________________ provides training to employees on Hepatitis B vaccinations,addressing safety, benefits, efficacy, methods of administration andavailability.For more information on training requirements see pages 30-33 in this Exposure Control Plan.EMPLOYER PAGEATTENTIONOSHA EXPOSURE CONTROL PLAN…a member benefit from the WDA 23
Page 4 and 5: TABLE OF CONTENTSHEPATITIS B VACCIN
Page 6 and 7: EXPOSURE CONTROL PLAN, PURPOSE AND
Page 8 and 9: EXPOSURE DETERMINATIONDEFINITIONOSH
Page 10 and 11: EXPOSURE DETERMINATION FORMFor use
Page 12 and 13: ENGINEERING AND WORK PRACTICE CONTR
Page 14 and 15: NEEDLESTICK SAFETY AND PREVENTION A
Page 20 and 21: PERSONAL PROTECTIVE EQUIPMENTThe pe
Page 22 and 23: PERSONAL PROTECTIVE EQUIPMENT CONTI
Page 24 and 25: HOUSEKEEPING CONTINUEDC. IN-HOUSE L
Page 28 and 29: HEPATITIS B VACCINATION DECLINATION
Page 30 and 31: POST-EXPOSURE EVALUATION AND FOLLOW
Page 32 and 33: OCCUPATIONAL EXPOSURE INCIDENT REPO
Page 34 and 35: INFORMATION AND TRAININGIn this Den
Page 36 and 37: OSHA BLOODBORNE PATHOGENS STANDARD
Page 38 and 39: RECORD KEEPINGIn this Dental Office
Page 40 and 41: APPENDIXEMPLOYER REFERENCE PAGESOCC
Page 42 and 43: APPENDIXThe Hepatitis B vaccine doe
Page 44 and 45: APPENDIXEMPLOYER FREQUENTLY ASKED Q
Page 46 and 47: APPENDIXWEB SITES FOR REFERENCE DOC
Page 48 and 49: APPENDIXOSHA EXPOSURE CONTROL PLAN
Page 50 and 51: APPENDIXONLY FOR EMPLOYERS HIRING M
Page 52 and 53: OSHA EXPOSURE CONTROL PLAN…a memb

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