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Fcps tb screening form

Tb screening form 2026

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The document is a TB Screening Form required annually for employees enrolled in the UAB OH&S Employee Health Program who have positive TB skin tests. It includes sections for personal information, medical history related to tuberculosis, and symptoms experienced within the past year. Employees must answer questions truthfully and certify the accuracy of their responses, acknowledging that a 'Yes' answer may lead to further evaluation by UAB Employee Occupational Health.

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Click ‘Get Form’ to open the TB Screening Form in the editor.
Begin by entering your personal information. Fill in your name, Blazer ID, and date at the top of the form.
Proceed to answer the questions truthfully. For each question, either fill in the blank or circle 'Y' for Yes or 'N' for No as appropriate.
For questions regarding your medical history, such as previous tests and symptoms, provide detailed responses where required.
If you answered 'Yes' to any questions about potential TB exposure or symptoms, ensure you provide explanations in the designated area.
Finally, sign and date the form at the bottom. Ensure a witness also signs if required.

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