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Click ‘Get Form’ to open the TB Screening Questionnaire in the editor.
Begin by entering your name in the designated field at the top of the form.
Next, provide the date of your positive PPD test using the format (m/d/y).
Fill in the date of your last chest x-ray, again using (m/d/y) format.
Review the list of symptoms and indicate 'YES' or 'NO' for each symptom you have experienced for three to four weeks or longer since your last chest x-ray.
At the bottom of the form, confirm that your health statement is true and accurate by signing in the provided space.
Finally, enter today's date next to your signature before submitting the completed form along with any required documentation.

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What does TB screening involve?

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 TB questions?

Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis (M. tuberculosis). The bacteria, or germs, usually affect the lungs. TB germs can affect any part of the body, such as the kidneys, spine, or brain.

What not to do before a TB test?

In general, theres nothing you have to do before this test, unless your healthcare provider asks you to.

What questions do they ask for TB screening?

Employers often require tuberculosis (TB) tests to ensure a safe and healthy work environment, particularly in industries where employees interact closely with others, such as healthcare, education, and food services.

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?

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TB Screening Questionnaire - All Health Services 2026

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