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Hepatitis B Questionnaire

For Orange Grove Personnel Only

Please note the policy below regarding the Hepatitus B vaccine series. Please let us know if you would like to take advantage of this vaccine, by complete the following simple questionnaire:


Hepatitis B Questionnaire

Email Address 
Phone Number 
No, I do not want the Hepatitus B Vaccine to protect me and the people I serve.
Yes, I would like to have the Hepatitus B Vaccine to protect me and the people I serve.
To prove you are a human, please tell us which has two legs?

 Orange Grove Center

Hepatitis B Vaccine Policy

All OGC employees who have been identified as having the potential of being exposed to blood or other potentially infectious materials will be offered the Hepatitis B vaccine, at no cost to the employee.

The vaccine will be offered after training and within 10 working days of the employee’s initial assignment, unless the employee has previously received the vaccine series, antibody testing has revealed that the worker is immune, or the vaccine is contraindicated for medical reasons.

Employees have the right to decline the vaccination.  All employees who decline must sign a declination form.

Any employee who initially declines to receive the vaccine, but at a later date decides to accept it, will be offered the vaccine at no cost, provided the employee still has the potential of being exposed.




This page was last updated on Mon Feb 6, 2017.

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Orange Grove Center • 615 Derby Street • Chattanooga, Tennessee 37404 • Phone: 423.629.1451