Login Event Calendar Careers About NACCHO Contact Us Site Map

Return to Toolbox Main.

Screening Questionnaire for High Risk Hepatitis Vaccination Eligibility


Columbus Public Health designed this one page questionnaire as a self-administered screening form for adult clients.  Vaccine providers at local health departments can use this to determine eligibility for the Hepatitis B Virus (HBV) vaccine among clients at disproportionate risk for HBV infection. 

Click here for NACCHO's Collection of Adult Hepatitis B Virus (HBV) Vaccination Tools and Resources.

Primary Toolkit:

Infectious Disease Prevention and Control Toolkit

Keyword Area:

Immunization, Infectious Diseases, Screening


Institutional Author:

Columbus Public Health





The NACCHO Toolbox is a repository of available resources to help local public health practitioners. Tools are produced by local, state, and federal agencies, as well as academic institutions and other stakeholders. The contents of this Toolbox are solely the responsibility of the authors and do not necessarily reflect any official recommendations of NACCHO. NACCHO makes no express or implied warranty with respect to the contents and disclaims liability for any damages arising from or connected to the use of the material in this Toolbox.