I understand the risks and benefits of the TB skin test and request the test be given to me. I understand that if I am symptomatic for TB or if the TB skin test is positive, results may be …

This form is to be used for persons who are required to have TB screening for employment, post-secondary educational institution admission, long term residential care admission, correctional …

Dec 19, 2023 · TB screening for health care personnel includes a risk assessment, symptom evaluation, and TB test.

Over the past 2 years, have any close friends or family members had symptoms of active tuberculosis (Please circle all that apply: persistent cough over 2 weeks, unexplained weight …

Have you been diagnosed with Infectious TB since completing your last TB questionnaire?

ADULT TUBERCULOSIS (TB) RISK ASSESSMENT QUESTIONNAIRE (To satisfy California Education Code Section 49406 and Health and Safety Code Sections 121525‐121555)

For the following persons who are at highest risk of developing active tuberculosis disease if they are infected, tuberculin skin tests are considered positive at 5mm of induration or larger.

Settings that require TB screening may use this form to identify adults with signs or symptoms of TB disease who may need further medical evaluation.

__________________________________ _______________ HCP Signature Date Upon review of the responses to the questionnaire and discussion with the person for whom the …

This form is to be used annually when an employee or child has increased risk or a positive result occur from Tuberculosis screening using either skin testing (PPD) or blood sample (QFT-G or …