Employee Health Tuberculosis Assessment Form - texaschildrens 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name, date, work location, and department in the designated fields at the top of the form.
3. Fill in the details regarding your last TB skin test, including the date administered and results. Indicate whether it was positive or negative.
4. If applicable, complete the section for TB Questionnaire for Positive Skin Test Reactors by checking 'Yes' or 'No' for each symptom listed.
5. Answer additional questions regarding travel history and medical conditions that may affect your immune system. Provide details if you answered 'Yes' to any of these questions.
6. Finally, sign and print your name along with the date at the bottom of the form. Ensure all information is accurate before submission.

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