School Staff and Volunteers: Tuberculosis Risk Assessment - cdph ca 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the 'Name of Employee/Volunteer Assessed for TB Risk Factors' along with the 'Assessment Date' and 'Date of Birth'. These fields are essential for identifying the individual being assessed.
  3. In the section titled 'History of Tuberculosis Infection or Disease', check either 'Yes' or 'No'. If 'Yes', ensure that a symptom review and chest x-ray are performed by a qualified health care provider.
  4. If you selected 'No', proceed to assess risk factors. Check any applicable boxes under 'Risk Factors for Tuberculosis'. This will determine if further testing is necessary, such as a Mantoux tuberculin skin test (TST) or Interferon Gamma Release Assay (IGRA).
  5. Complete the Certificate of Completion section at the end of the form, ensuring that a health care provider signs off on the assessment results.

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Per California Education and Health and Safety Codes, the TB risk assessment is to be administered by a health care provider. The risk assessment should be administered face-to-face. However, given the COVID-19 emergency response, the TB risk assessment may also be administered via telehealth.
For more information, please visit: . School entrants require a Pediatric TB risk assessment and if indicated, a test. The form typically used is the PM 171A - Report of Health Exam for School Entry .
Testing for TB is crucial because it helps identify those who are infected, even if they do not show symptoms. This is especially important in school settings to prevent the spread of TB among students and staff.
NOTE: School governing authority can require more frequent or more extensive examinations. Employees with negative skin tests: Repeat skin test every 4 years. Employees with positive skin tests: Must furnish a certificate from a health provider every 4 years showing that employee is free from active TB.
All children must see a clinician wholl decide if they need a chest x-ray. Children under 11 will not normally have a chest x-ray. You must take your child to an approved clinic and complete a health questionnaire. If the clinician decides your child does not have TB theyll give you a certificate.
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CDC recommends all U.S. health care personnel should be screened for TB upon hire. Annual TB testing is not recommended unless there is a known exposure or ongoing transmission. State and local TB regulations may differ.
Perform annual screening for symptoms of TB disease. Annually reevaluate the risk and benefits of treatment for latent TB infection. Ensure health care personnel know the symptoms of TB disease that should prompt an immediate evaluation between screening.

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