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Tuberculosis TB Screening Questionnaire and

Tuberculosis TB Screening Questionnaire and 2025

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The document is a Tuberculosis (TB) Screening Questionnaire designed for healthcare workers, contractors, and volunteers. It collects personal information and medical history related to TB exposure and symptoms. The questionnaire includes questions about previous TB tests, treatment history, and current health issues. It also outlines the process for submitting the completed form to Employee Health divisions for further evaluation and record-keeping.

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Click ‘Get Form’ to open the Tuberculosis TB Screening Questionnaire in the editor.
Begin by filling in your personal information, including your last name, first name, middle initial, department, location, phone number, and date of birth. Ensure you use black ink for clarity.
Answer the questions regarding your TB history. For each question, select 'Yes' or 'No' as applicable. If you have a history of a positive TB test, provide the dates for both the skin and blood tests.
If you answered 'Yes' to having a positive TB test, indicate whether you were treated with INH.
Respond to the symptoms listed in Question 3 by marking 'Yes' or 'No' for each symptom experienced over the past year.
Sign and date the form at the bottom to acknowledge that your answers are true. This is crucial for processing your screening.
Submit your completed form via email or fax to your local Employee Health division as indicated on the document.

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Versions	Form popularity	Fillable & printable
2020	4.3 Satisfied (35 Votes)
2017	3.7 Satisfied (64 Votes)

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What are the 2 other names for a TB test?

Tuberculin skin tests (TST) are administered to detect the presence of Mycobacterium tuberculosis, the bacterium that causes tuberculosis (TB). The terms Mantoux, TB skin test, tuberculin skin test, and PPDs are often used interchangeably. Mantoux refers to the technique for administering the test.

What is the primary screening for TB?

The primary screening method for tuberculosis (TB) infection (active or latent) is the Mantoux tuberculin skin test with purified protein derivative (PPD). An in vitro blood test based on interferon-gamma release assay (IGRA) with antigens specific for Mycobacterium tuberculosis can also screen for latent TB infection.

What are the two methods of screening for TB?

Screening for TB infection (Latent TB Infection LTBI) There are currently two methods for detecting tuberculosis infection: The Mantoux tuberculin skin test (TST) and an Interferon Gamma Release Assay (IGRA) blood test. Patients must be carefully assessed for risk factors PRIOR to administration of either 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.

Which two tests are acceptable for TB screening?

You will have either be a TB skin test or a TB blood test, depending on your health and medical history. TB skin tests are used more often, but blood tests for TB are becoming more common. For a TB skin test (also called a Mantoux tuberculin skin test), you will need two visits to complete the test.

What are three other tests for TB?

Tests to check for tuberculosis (TB) an X-ray, ultrasound, echocardiogram or CT scan of your chest or the part of your body that may be affected. taking samples of your mucus (phlegm) a biopsy to take a sample of tissue, cells or fluid from the affected area.

What is a two test TB test?

In this procedure a person is given a baseline PPD test. If the test is negative, a second test is administered one to three weeks later. If the second test is negative, the person is considered uninfected.

Tuberculosis TB Screening Questionnaire and 2025

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