Transcription of TETANUS, DIPHTHERIA, PERTUSSIS (TDAP) DECLINATION
1 TETANUS, diphtheria , PERTUSSIS ( tdap ) DECLINATION I decline the tdap vaccine. I understand that by declining this vaccine, I continue to be at risk of acquiring Tetanus, diphtheria , or PERTUSSIS , serious diseases. If, in the future, I continue to have occupational exposure and want to be vaccinated with tdap vaccine, I can receive the vaccination at no charge to myself, while on assignment with HealthSource Global Staffing. I accept the responsibility to inform HealthSource Global Staffing of this decision at that time.
