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0 0 0 rg 0 0 0 rg EMC 0.5 0.5 0.5 rg f Adult Tuberculosis Risk Assessment •Use this tool to identify asymptomatic . endstream endobj 88 0 obj <>/Subtype/Form/Type/XObject>>stream California School Employee Tuberculosis (TB) Risk Assessment Questionnaire (for pre-K, K-12 schools and community college employees, volunteers and contractors) Use of this questionnaire is required by California Education Code sections 49406 and 87408.6, and Health and Safety Code sections 1597.055 and 121525-121555.^ 0.5 0.5 0.5 rg TB RISK ASSESSMENT INSTRUCTIONS For the following persons who are at highest risk of developing active tuberculosis disease if they are infected, tuberculin skin tests are considered positive at 5mm of induration or larger. H�2�3U0��t.=0a�gn�`�gb�P�ʕ�e� �@�zf endstream endobj 97 0 obj <>/Subtype/Form/Type/XObject>>stream �z& 1.68 1.92 5.04 7.32 re /Tx BMC 0.84 0.84 6.72 9.48 re California School Employee Tuberculosis (TB) 5/06/20 Risk Assessment Questionnaire (for pre-K, K-12 schools and community college employees, volunteers and contractors) Use of this questionnaire is required by California Education Code sections 49406 and 87408.6, and Health and Safety Code sections 1597.055 and 121525-121555. ɠq�"XP�S4�؈��XP4�� endstream endobj 56 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 41 0 obj <>/Subtype/Form/Type/XObject>>stream 1.68 1.92 5.04 7.32 re After 2 years of age, risk assessment for tuberculosis should be performed annually. H�2�3U0��t.=0a�gn�`�gb�P�ʕ�e� �@�zf 0.84 0.84 6.72 9.48 re 147 0 obj <>/Filter/FlateDecode/ID[]/Index[21 192]/Info 20 0 R/Length 225/Prev 173945/Root 22 0 R/Size 213/Type/XRef/W[1 3 1]>>stream If you are found to be “at risk” for latent TB infection, LTBI means the M. tuberculosis bacteria is present, but you do not show any signs or symptoms. Please see Tuberculosis Screening for Children in Childcare fact sheet for more information. Persons initially employed by a school district, or employed under contract, in a certificated or classified position (California Education Code, Section 49406) b. 0.84 0.84 6.72 9.48 re 0.5 0.5 0.5 rg endstream endobj 91 0 obj <>/Subtype/Form/Type/XObject>>stream %PDF-1.6 %�� TB risk assessment. 0.84 0.84 6.72 9.48 re Select �z�F #�� 212 0 obj <>stream If YES to any questions in Part A clearance for active TB is required prior to placement . endstream endobj 109 0 obj <>/Subtype/Form/Type/XObject>>stream f |Әo?��o��f�i��ͷ�g�\3��7û�>�6�Y��T# �aӖ�M��twaZ�o�:�"ݶ��n��V�1gAm�M�A��N�ʶwf;��E%� ��6��Ms�l�lg�o'�ę�B?�!m�M7{ 0 0 0 rg 0.84 0.84 6.72 9.48 re �z�F �z�F #�� z�F #�� endstream endobj 46 0 obj <>/Subtype/Form/Type/XObject>>stream EMC 0 0 0 rg endstream endobj 95 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC 0.84 0.84 6.72 9.48 re User Guide. endstream endobj 74 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 114 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 22 0 obj <> endobj 23 0 obj <>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Type/Page>> endobj 24 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 117 0 obj <>/Subtype/Form/Type/XObject>>stream %%EOF San Diego Tuberculosis Risk Assessment Use this tool to identify asymptomatic persons for latent TB infection (LTBI) testing. �z�F EMC endstream endobj 92 0 obj <>/Subtype/Form/Type/XObject>>stream �z�F endstream endobj 69 0 obj <>/Subtype/Form/Type/XObject>>stream 0.5 0.5 0.5 rg f �z�F #�� TB Screening Requirements for Child Care/School Staff and Volunteers. �z�F #�� Ɂm��fC�L�� "��uYY�>�n�S�a��7'�y ��&]�y{�020M4 �,@:��t5��YwOo]}cs�R�/��\|b2��^�>�.j[��n�\�uq��f-�[ȥ��7Ϯ��tq��L*�=R�J�-\�e`��Y��̂�e 7F�� 0 0 0 rg Download Pediatric Tb Risk Assessment Questionnaire California doc. �z�F 1.68 1.92 5.04 7.32 re 1.68 1.92 5.04 7.32 re �z�F #�� endstream endobj 82 0 obj <>/Subtype/Form/Type/XObject>>stream 0.84 0.84 6.72 9.48 re endstream endobj 115 0 obj <>/Subtype/Form/Type/XObject>>stream 0 0 0 rg f endstream endobj 45 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 90 0 obj <>/Subtype/Form/Type/XObject>>stream �й+�,8?�1H5(7�gx��a�`[�ǠT�T| �;��A�!�!�aSs��(� After submitting your TB screening responses, return to the “Compliance Forms” page. �z& PEDIATRIC TB RISK ASSESSMENT INSTRUCTIONS Tuberculosis risk assessment should be performed at first contact with a child and every 6 months thereafter for the first 2 years of life. Take you have tb risk questionnaire, endstream endobj 59 0 obj <>/Subtype/Form/Type/XObject>>stream �z& endstream endobj 34 0 obj <>/Subtype/Form/Type/XObject>>stream 0.5 0.5 0.5 rg �z& endstream endobj 29 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 58 0 obj <>/Subtype/Form/Type/XObject>>stream Employee Information. endstream endobj 79 0 obj <>/Subtype/Form/Type/XObject>>stream H�2�3U0��t.=0a�gn�`�gb�P�ʕ�e� �@�zf H�2�3U0��t.=0a�gn�`�gb�P�ʕ�e� �@�zf endstream endobj 60 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 35 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 99 0 obj <>/Subtype/Form/Type/XObject>>stream I҆�$M�(�,Ё��*�l8op�qfS�#�?E:�4 *�'�X� ��50�G4�>4��h�}�;�� W�w��F��wĦ��#b�uC��3��WZ)��Q�};��D��'�w^}W��L7��Og��9�t��dqZ.З�v? EMC 0.84 0.84 6.72 9.48 re f �z& endstream endobj 31 0 obj <>/Subtype/Form/Type/XObject>>stream �z& endstream endobj 43 0 obj <>/Subtype/Form/Type/XObject>>stream f endstream endobj 103 0 obj <>/Subtype/Form/Type/XObject>>stream 0 1.68 1.92 5.04 7.32 re 0.5 0.5 0.5 rg /Tx BMC endstream endobj 87 0 obj <>/Subtype/Form/Type/XObject>>stream R based on the results of the TB risk assessment, for the following groups: a. DOH 343-144 March 2019 . endstream endobj 71 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 62 0 obj <>/Subtype/Form/Type/XObject>>stream To read our latest Blog Postings click here. H�2�3U0��t.=0a�gn�`�gb�P�ʕ�e� �@�zf In the private healthcare sector a child should have a TB Risk Assessment performed at every well-child visit. The California Tuberculosis Risk Assessment is a product developed jointly by the Tuberculosis Control Branch at the California Department of Public Health (CDPH), the California Tuberculosis Controllers Association (CTCA), and the Curry International tuberculosis Center (CITC). f f endstream endobj 111 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 123 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 76 0 obj <>/Subtype/Form/Type/XObject>>stream California Adult TB Risk Assessment. 0.5 0.5 0.5 rg f f H�2�3U0��t.=0a�gn�`�gb�P�ʕ�e� �@�zf Adult Tuberculosis (TB) Risk Assessment Questionnaire 1 (To satisfy California Education Code Section 49406 and Health and Safety Code Sections 121525‐121555) To be administered by a licensed health care provider (physician, physician assistant, nurse practitioner, registered nurse) 0 0 0 rg 1.68 1.92 5.04 7.32 re /Tx BMC endstream endobj 86 0 obj <>/Subtype/Form/Type/XObject>>stream 1.eplaces the mandated TB examination on initial employment with a TB risk assessment, and TB testing. 0 0 0 rg endstream endobj 93 0 obj <>/Subtype/Form/Type/XObject>>stream Complete the TB questionnaire (assessment form) Deadline July 15th. endstream endobj 47 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 84 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 94 0 obj <>/Subtype/Form/Type/XObject>>stream For school district volunteers with “frequent or prolonged contact with pupils,” mandates a TB risk assessment questionnaire administered on initial volunteer assignment and TB testing based on the results of the TB risk assessment. /Tx BMC h�bbd```b``M�� )�^"W�I0�a�}L��"P�oH�`�կD�w��J�i��3PI��gDg8��#R�ɵꉲ��&��j��^��&Cc �$9f�eA$s�� &��$/�d��7`RA�#�0i�$�s�-&�A��B�dc� �o�&`��8J �� @� ��^9 EMC /Tx BMC 0.84 0.84 6.72 9.48 re �z& endstream endobj 50 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 112 0 obj <>/Subtype/Form/Type/XObject>>stream 0.5 0.5 0.5 rg Test ONLY those with a risk for TB. 1.68 1.92 5.04 7.32 re 0.5 0.5 0.5 rg f H�2�3U0��t.=0a�gn�`�gb�P�ʕ�e� �@�zf 0.84 0.84 6.72 9.48 re �>�e��v)��ȃ��j�I�hhD��Es��V->U?�g��z��:�y��AL��&uA��v�#��|^Uo'����Nv�B65YGT�v��d-��òFh6��6��tu�� Today's Date. California School Employee Tuberculosis (TB) CONTROLLERS ASSOCIATION Risk Assessment Questionnaire (for pre-K, K-12 schools and community college employees, volunteers and contractors) •Use of this questionnaire is required by California Education Code sections 49406 and 87408.6, and Health and Safety Code sections 1597.055 and 121525-121555.^ Adapted from the California Risk Assessment Tool and User Guide. f �z�F #�� f 0.84 0.84 6.72 9.48 re H�2�3U0��t.=0a�gn�`�gb�P�ʕ�e� �@�zf 0.5 0.5 0.5 rg �z�F H�2�3U0��t.=0a�gn�`�gb�P�ʕ�e� �@�zf 0.84 0.84 6.72 9.48 re 1.68 1.92 5.04 7.32 re /Tx BMC /Tx BMC endstream endobj 37 0 obj <>/Subtype/Form/Type/XObject>>stream H�2�3U0��t.=0a�gn�`�gb�P�ʕ�e� �@�zf f endstream endobj 64 0 obj <>/Subtype/Form/Type/XObject>>stream 1.68 1.92 5.04 7.32 re children. Please begin this process early to avoid delays. /Tx BMC /Tx BMC f �z�F 21 0 obj <> endobj OUR MISSION. ü³èµD?äÆÉ^÷§¸Ãg¸zÑÐ¤M-iËIZ³]I_¯^ÚF»ÈÇtm÷è. 0 0 0 rg endstream endobj 67 0 obj <>/Subtype/Form/Type/XObject>>stream �z& �z�F #�� H�2�3U0��t.=0a�gn�`�gb�P�ʕ�e� �@�zf 0.5 0.5 0.5 rg 0.5 0.5 0.5 rg /Tx BMC 0 0 0 rg endstream endobj 119 0 obj <>/Subtype/Form/Type/XObject>>stream EMC endstream endobj 106 0 obj <>/Subtype/Form/Type/XObject>>stream �z& with infectious tuberculosis (TB) to prevent them from spreading TB. Adult Tuberculosis (TB) Risk Assessment Questionnaire EiCTCA CONTROLLERS ASSOCIATION Name: (To satisfy California Education Code Section 49406 and Health and Safety Code Sections 121525-121555) To be administered by a licensed health care provider (physician, physician assistant, nurse practitioner, registered nurse) Date of Risk Assessment: Have new risk factors for TB as indicated by their responses on the results of the following factors... 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