Tuberculosis (TB) Prevention Forms and Checklists

NKY Health's Safety Manual
  • Replaces: Supersedes all previous information on the same topic
  • Reviewed: Annually
  • Section Revised: Separated from Prevention of Tuberculosis Transmission Plan and Moved to Google Sites 1/1/2022, Revised 1/1/2022
  • Contact: Employee Health Nurse and Safety Staff

TB Skin Testing Declination Form

Declination of Tuberculosis Skin Test.pdf

Annual TB Risk Assessment Form

TB4 TB Risk Assessment Form.pdf

TB Exposure control Training Record

Tuberculosis Exposure Control Training Record.pdf

OSHA Respirator Medical Evaluation Mandatory Questionnaire

(This form is Appendix C to CFR 1910.134.) 

OSHA Questionnaire.pdf