If your job involves Invasive Procedures (Operations or surgical procedures, Including midwifery) you may need to provide documentation from a PHLS accredited UK laboratory of screening for Hepatitis B, Hepatitis C and HIV or be prepared to undergo testing. If you do not know if this applies to you call the number at the top of this form to ask for OH advice.
If your job is on the Renal Unit, involving the haemodialysis process, you must provide written evidence of your Hepatitis B Surface Antigen. Please attach all documentation to this form.
DECLARATION I have answered these questions completely and truthfully to the best of my knowledge and belief. I agree to attend for any further necessary advice related to immunisations or follow up checks which are required for my job.