APPENDIX XV: BLOODBORNE PATHOGEN EXPOSURE REFUSAL OF FOLLOW-UP

I understand that due to my exposure to blood or other body fluid, possibly infected with bloodborne pathogens, I am being offered medical/counseling follow-up services. However, I decline the follow-up services at this time. I understand that by declining the service, I continue to be at risk of acquiring hepatitis B virus or other bloodborne pathogen infection. If in the future I decide to take advantage of the follow-up services, they will be at that time be made available to me.

Original: Department Files

Copy: Department of Environmental Health and Safety

          Employee