Details for Influenza Immunization - declination forms

We have not written a policy as such. We advertised that it is now State law (California) and that all employees had to complete and turn in the flu form. We put the consent/declination on the same page.

I used a template issued from the California DPH. Since we have already held our flu shot campaign, I have already edited the form for next year to eliminate some of the errors employees were making filling it out.

Our facility sets a date every year by which all employees must have completed their mandatory TB evaluation (PPD or TB questionnaire) and Flu vaccination/declination. Anyone not in compliance by that date is considered to have voluntarily resigned. Anyone getting close to that date will already have faced disciplinary suspension by their manager.

I am attaching my revised form below.