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Annual tuberculosis symptom questionnaire

Annual tb screening questionnaire form 2026

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The document is an annual Occupational Questionnaire for employees with a history of positive tuberculosis (TB) tests. It collects personal information, previous treatment details, and assesses potential TB exposure and symptoms to ensure ongoing health monitoring and evaluation.

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Click ‘Get Form’ to open the annual TB screening questionnaire in the editor.
Begin by entering your personal information: First Name, Last Name, Date of Birth, and Employee ID/SSN. This ensures accurate identification.
Fill in your Department and Supervisor's name for proper record-keeping.
Indicate the date of your previous positive TB test and the type of test taken. This is crucial for tracking your medical history.
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.
Complete the section regarding chest X-ray details, including the date and results.
Respond to questions about potential TB exposure over the past year, including any isolation room visits or close contacts with TB patients.
Review symptoms listed in the Sign and Symptom Review section. Mark 'Y' for yes or 'N' for no as applicable.
For any 'YES' answers, provide additional details in the space provided to ensure thorough documentation.
Finally, sign off on any recommendations for medical evaluation or chest X-ray as indicated by your responses.

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What are the four questions for TB screening?

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 involved in a TB screening?

For a TB test in blood (also called an IGRA test), a health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out.

What are 4 ways to test for TB?

Asking you questions about your symptoms. TB tests. Your healthcare professional will order tests if: Skin test. A tiny amount of a substance called tuberculin is injected just below the skin on the inside of one forearm. Blood tests. A sample of blood is sent to a lab. X-ray. Sputum tests. Other lab tests.

Does OSHA require annual TB testing?

In addition, OSHA requires that all other employees who share the air in the same building or facility be offered an annual TB skin test.

What is an annual TB screening?

TB screening is a process that includes: A baseline individual TB risk assessment, TB symptom evaluation. A TB test (e.g., TB blood test or a TB skin test), and. Additional evaluation for TB disease as needed.

annual tb symptom questionnaire

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Where can I get my annual TB test?

You can get tested for TB at the health department or at your health care providers office. Your health care provider will choose the TB test that is best for you. Public and private health care plans may cover TB testing costs.

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?

What are the 4 symptom screening for TB?

The World Health Organization (WHO) recommends that PLHIV, including pregnant women, should be routinely screened for symptoms of active TB at every health facility visit using a four‐symptom screen (cough, fever, night sweats, and weight loss (WHO 2011a).