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EMPLOYEE HEALTH TUBERCULOSIS (TB) SCREENING

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Do you currently have any of the following that has lasted 3weeks or longer?

1. Unexplained productive cough
2. Unexplained weight loss?
3. Unexplained appetite loss?
4. Unexplained fever?
5. Night sweats?
6. Shortness of breath?
7. Chest pain?
8. Increased Fatigue?
9. Body Sputum?
Have you:
Ever been told you have TB?
Lived with anyone with TB?
Had a positive TB skin test?
Had a BCG vaccination?
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Do you have documentation of a negative TB skin test or TB health screening within the last 12 months?
Clear Signature
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