Annual TB Questionnaire

The Annual Tuberculosis (TB) Questionnaire is designed to assess your current TB health status and identify any potential symptoms or risk factors associated with tuberculosis. This yearly screening helps ensure a safe and healthy environment for you and those around you.

Please note that we do not use the Tuberculin Skin Test (PPD or Mantoux test) as part of this annual evaluation. Instead, this questionnaire focuses on symptom review, exposure history, and medical background to determine whether further medical evaluation is necessary.

Why This Questionnaire Is Important

• Helps detect possible TB symptoms at an early stage
• Protects the health and safety of employees, patients, and the community
• Ensures compliance with health and safety guidelines
• Determines whether additional medical testing or evaluation is required

Who Should Complete This Form

All individuals required to undergo annual health screening must complete this questionnaire, even if:

• You feel healthy and have no symptoms
• You previously tested negative for TB
• You have completed TB treatment in the past

What You Will Be Asked

The questionnaire may include questions about:

• Persistent cough, fever, night sweats, or unexplained weight loss
• Recent exposure to someone diagnosed with TB
• Travel history to areas where TB is common
• Previous TB diagnosis or treatment
• Any recent medical evaluations related to TB

Please answer all questions honestly and completely. Your responses are confidential and used only for health screening purposes.

After You Submit the Questionnaire

• If no risk factors or symptoms are identified, no further action is required.
• If symptoms or risks are reported, you may be contacted for additional medical evaluation or testing.
• Follow any instructions provided by your healthcare or occupational health team.