TB screening form 06082011 2 - hsc unt 2026

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The document is a Tuberculosis (TB) Skin Testing Form that provides information and consent for the TB skin test, detailing the nature of TB, potential side effects, precautions, and instructions for health care workers. It includes sections for risk assessment, administration of the test, interpretation of results, and referral procedures if necessary. The form emphasizes the importance of screening for TB among health care workers and outlines steps to take if there are any previous positive reactions or symptoms related to TB.

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Click ‘Get Form’ to open the TB screening form in the editor.
Begin with SECTION I: INFORMATION/CONSENT. Fill in your name, department, and signature. Ensure you read the consent information carefully before signing.
Proceed to SECTION II: RISK ASSESSMENT. Answer each question by checking 'Yes' or 'No'. Provide additional details where necessary, especially regarding past TB tests and symptoms.
In SECTION III: PPD ADMINISTRATION, record the date given and site of administration (right or left forearm). If applicable, note the second step date and PPD lot number.
Complete SECTION V: INTERPRETATION and REFERRAL by entering the date read and results in millimeters for both steps. Ensure the reader's signature is included.

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