Download Tetanus Form

Private & Confidential
RSPCA Volunteer
Tetanus Form
Tetanus is a bacterial disease caused by an infection in an open wound. It causes a
continuous, painful contraction of some or all of the body’s muscles, which usually
results in violent spasms and rending of the muscles. The disease is life threatening,
even with intensive care and support for victims.
In view of this, it is not surprising that everyone should be inoculated to prevent
infection. In order to comply with our responsibilities under Health and Safety at
work, it is now a requirement that all RSPCA staff and volunteers must be suitably
protected, except for extenuating circumstances.
Normally, nowadays, all school children are inoculated at the age of 14 and as
protection lasts for 10 years, if you are under the age of 24 you should already be
protected. If you are over 24, please ensure that your vaccination is up to date. Some
sources advocate that in ‘high risk’ professions, such as animal husbandry,
vaccination should be renewed every 5 years and not every 10, but some doctors do
not agree with this. Please check with your own general practitioner to ensure you
are in date and protected.
Please complete the following statement, sign it and return a copy along with the
application form and medical questionnaire.
I, …………………………………………………………(Please print full name)
of (Address)
…………………………………………………………………………………………
…………………………………………………………………………………………
…………………………………………………………………………………………
have read and understood the directive regarding tetanus and understand that I should
be protected against the disease.
1. I confirm that I am still protected.
Signed………………………………………… Date…………………………
2. I can not be protected for the following medical reasons:
………………………………………………………………………………………….
Signed……………………………………….. Date………………………….
If not protected I understand that I am volunteering here at my own risk and the
RSPCA cannot be held responsible.
Signed……………………………………….. Date………………………….