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Click ‘Get Form’ to open the tb screening risk assessment questionnaire in the editor.
Begin by entering your First Name, Last Name, and Employee ID in the designated fields at the top of the form.
Indicate the date of your previous positive TB test and select the type of test you underwent (IGRA or TST) by circling one option.
Answer whether you have taken medications following your positive TB test. If yes, confirm if you completed the entire course and provide the treatment completion date.
Fill in the date of your last chest x-ray and its results in the respective fields.
Respond to each question regarding potential TB exposure over the past year, providing details where necessary.
Complete the sign and symptom review section by marking 'Yes' or 'No' for each symptom listed.
If any symptoms are marked as 'Yes', provide additional details on a separate page as instructed.
Finally, indicate whether a medical evaluation or chest x-ray is recommended and sign off with evaluator’s initials and date of evaluation.

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How do I prepare for TB screening?

Will I need to do anything to prepare for the test? You dont any special preparations for TB skin test or a TB blood test.

What are the 4 TB screening questions?

Please answer the following questions: Have you ever had a positive TB skin test? Have you ever had close contact with anyone who was sick with TB? Have you ever been vaccinated with BCG? * The significance of the travel exposure should be discussed with a health care provider and evaluated.

What is the gold standard for TB screening?

All specimens should be cultured, regardless of whether the smear is positive or negative. Culture is the gold standard for laboratory confirmation of TB disease. A positive culture for M. tuberculosis confirms the diagnosis of TB disease.

What questions to ask when screening for TB?

Tuberculosis Risk Assessment Have you had a cough lasting more than three weeks? Have you lived with or spent time with anyone who had or may have had TB? Have you lived in or visited any of the following areas for more than a month: Africa, Asia, Mexico, Central or South America, the Caribbean or Eastern Europe?

Can an RN do a TB risk assessment?

If you are located at a school site, the California School Employee TB Risk Assessment Questionnaire can be completed in-person with the school site Registered Nurse.

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