Seasonal Influenza AttestationDeclination Form Broward Health Browardhealth

What is the Seasonal Influenza Attestation Declination Form?

The Seasonal Influenza Attestation Declination Form is a document used primarily in healthcare settings to formally decline the influenza vaccination. This form serves as a record that an individual has opted out of receiving the flu vaccine, often required by employers, particularly in health-related fields. By submitting this form, employees acknowledge their decision and may be required to provide reasons for their declination, ensuring compliance with workplace policies and health regulations.

Steps to Complete the Seasonal Influenza Attestation Declination Form

Completing the Seasonal Influenza Attestation Declination Form involves several straightforward steps:

1. Obtain the form from your employer or the designated health authority.
2. Fill in your personal information, including your name, position, and department.
3. Clearly state your reasons for declining the influenza vaccination in the designated section.
4. Sign and date the form to confirm your decision.
5. Submit the completed form to your supervisor or the human resources department as instructed.

Legal Use of the Seasonal Influenza Attestation Declination Form

The Seasonal Influenza Attestation Declination Form is legally recognized in the United States as a valid means for individuals to express their choice regarding vaccination. Employers must respect the decision documented in this form, provided it is filled out correctly and submitted according to company policies. This form helps protect employees' rights while also ensuring that employers maintain compliance with public health guidelines.

Key Elements of the Seasonal Influenza Attestation Declination Form

Key elements of the Seasonal Influenza Attestation Declination Form typically include:

• Personal Information: Name, job title, and department of the individual.
• Reason for Declination: A section where individuals can outline their reasons for opting out of the flu vaccine.
• Signature: A signature line for the individual to confirm their understanding and agreement.
• Date: The date of submission, which is important for record-keeping.

How to Obtain the Seasonal Influenza Attestation Declination Form

To obtain the Seasonal Influenza Attestation Declination Form, employees should contact their human resources department or the designated health services within their organization. Many employers provide this form electronically on their internal websites, ensuring easy access for all employees. If not readily available, employees can request a hard copy directly from HR personnel.

Examples of Using the Seasonal Influenza Attestation Declination Form

There are various scenarios in which the Seasonal Influenza Attestation Declination Form may be utilized:

• Healthcare workers who choose not to receive the flu vaccine for personal or medical reasons.
• Employees in educational institutions who are required to document their vaccination status.
• Individuals working in environments where flu vaccination is strongly encouraged but not mandatory.