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Employment TB Test

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EMPLOYMENT TB TEST

Personal Information

Position Information

Employment History (Most recent first)

Education

References (Professional)

Tuberculosis (TB) Screening Details

Test type (check all that apply): PPD (Mantoux) IGRA (Quantiferon/T-Spot) Chest X‑ray Medical history review

PPD (Mantoux) Details

Date placed:    Date read:    Induration (mm):

PPD result interpretation: Negative Positive Conversion (increase from prior)

IGRA (Blood Test) Details

Date drawn:    Date reported:

IGRA result: Negative Positive Indeterminate Value / notes:

Chest X‑Ray / Radiology

Date of chest x‑ray:

X‑ray result: Clear / No active TB Abnormal — see findings

TB History and Treatment

Prior positive TB test or history of TB disease: No Yes — if yes, provide details below

BCG vaccination: No Yes — if yes, approximate year:

Symptoms Screening

Currently experiencing any of the following: Persistent cough (>2 weeks) Night sweats Unexplained weight loss Fever Coughing up blood None of the above

Provider / Laboratory Information

Employer Determination

Based on the information and test results provided, the medical reviewer indicates: Cleared for employment with no restrictions Requires follow-up / additional evaluation Not cleared for work involving patient contact

Legal Disclosures

At‑Will Employment: Nothing in this screening form alters the employment relationship. Employment, if offered or continued, remains at‑will and may be terminated by either the employer or the employee at any time with or without cause and with or without notice, unless a separate written agreement provides otherwise.

Equal Opportunity: The employer adheres to a policy of equal employment opportunity and does not unlawfully discriminate on the basis of race, color, religion, sex, national origin, disability, age, or any other protected characteristic.

Applicant Certification & Authorization

I certify that all information provided on this form is complete and accurate to the best of my knowledge. I authorize the release of my TB screening results, chest x‑ray reports, and relevant medical information to the employer for the purpose of evaluating fitness for employment and compliance with workplace health requirements.

I authorize the employer and its designated agents to contact previous employers and health care providers as necessary to verify information relevant to this screening and to conduct any background checks required by the employer. I understand that false statements or omissions may be grounds for denial of employment or termination.

I authorize release of my TB screening results and related medical information to the employer and their agents for determination of fitness for duty.

By signing below I acknowledge that I have read and understand the statements above and that I have been given an opportunity to ask questions regarding the TB screening process.

Applicant Printed Name:

Signature:

Date:

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What the Employment TB Test Is and when it’s used

An Employment TB Test documents tuberculosis screening results required by employers to assess workplace health risk and meet industry or regulatory expectations. Common formats capture the employee’s identifying information, test type (TST/PPD or IGRA blood test), date administered, results, and the healthcare provider’s signature. Employers in healthcare, long-term care, education, and certain government roles typically collect a baseline test before or shortly after hire and maintain a confidential medical record. signNow is a secure, compliant eSignature solution many organizations use to collect and retain signed test records electronically.

Why an Employment TB Test matters for employers

The test documents an employee’s TB status to protect coworkers and vulnerable populations, support reasonable workplace controls, and demonstrate compliance with workplace health policies and applicable public health reporting obligations.

Why an Employment TB Test matters for employers

Which organizations and teams typically request this form

These groups commonly use the Employment TB Test to screen, document, and retain TB results.

  • Healthcare employers and occupational health teams responsible for staff screening and patient safety.
  • School districts and childcare providers screening staff for communicable disease risk.
  • Human resources departments managing pre-employment onboarding and health clearances.

Use and storage responsibilities usually fall to HR or occupational health, with access limited under medical privacy rules.

Core components that a professional Employment TB Test should include

A complete form groups identifying data, test administration details, results, clinician validation, follow-up actions, and retention notes for compliance and auditability.

Employee ID

Full legal name, date of birth, employee ID, and employer unit for unambiguous identification across HR and clinical systems.

Test type

Specify TST (PPD) or IGRA blood test, including manufacturer or method to clarify interpretation and follow-up requirements.

Administration details

Date and location of the test, administering clinician or clinic name, and lot number when applicable for chain-of-custody.

Result and interpretation

Clear result field (negative, positive, indeterminate) plus mm induration for TST and lab value reference ranges for IGRA.

Provider validation

Clinician signature, printed name, credentials, and clinic contact to support verification and follow-up care.

Follow-up actions

Recommended next steps, chest x-ray or treatment referrals, and a checkbox for clearance to work or restricted duties.

Step-by-step: filling out the Employment TB Test

Follow these steps in order to complete, validate, and file the test reliably.

  • 01
    Collect identity: Gather full legal name, DOB, employer unit, and contact details before testing.
  • 02
    Record test details: Enter test type, administration date, clinic, and lot details when available.
  • 03
    Enter results: Input result fields exactly and add measurement values for TST or IGRA.
  • 04
    Sign and route: Clinician signs, then route the completed form to HR or occupational health for retention.

Customizing an online workflow for the Employment TB Test

Map fields and routing so tests automatically reach occupational health and HR while maintaining access controls.

Field | Configuration Type | Required
Test Date Date picker | MM/DD/YYYY required
Test Type Dropdown | TST or IGRA required
Provider Signature Signature field | Required with role authentication
Routing Auto-route | Send to HR and occupational health

Technical considerations for eSubmission and signatures

Ensure the e-sign and storage platform supports secure authentication, audit trails, and the file formats your clinic uses.

  • Supported formats: PDF and DOCX are standard for signed test records.
  • Authentication: Use at least email verification; stronger 2FA or KBA for sensitive medical records.
  • Integrations: Integration with HRIS and cloud storage reduces manual routing.

Confirm platform compliance with applicable standards (HIPAA when handling PHI), test that routing preserves access controls, and document retention policies before live use.

Where completed Employment TB Tests are typically sent

A standard routing pattern minimizes handling and preserves confidentiality.

  • Occupational health: Primary clinical record kept for employee medical files and follow-up.
  • Human resources: HR receives clearance status or work restrictions, not detailed clinical notes.
  • Local health department: Report positives when required by public health surveillance laws.
  • Employee copy: Provide employee an accessible copy of their test record.

Typical timing and processing expectations

Timing depends on employer policy and public health guidance; ensure testing aligns with onboarding and exposure protocols.

Pre-employment baseline:

Collected before start date or at first worksite access per employer policy.

Post-exposure testing:

Conducted after suspected workplace exposure following public health guidance.

Periodic screening:

Some employers schedule periodic or annual screening by risk level.

Result reporting:

Positive results are reportable to public health per state rules.

Processing time:

Lab-based IGRA results often return within 48–72 hours; TST requires reading after 48–72 hours.

Essential data elements to capture on the form

Full name: Employee legal name
Date of birth: MM/DD/YYYY
Employer: Hiring organization
Test type: TST or IGRA
Result: Negative/Positive/Indeterminate
Provider: Clinician name and signature

Common mistakes to avoid when preparing the Employment TB Test

  • Using inconsistent names or IDs that prevent matching to HR records and delay clearance.
  • Omitting the test type or numeric measurement, making interpretation and follow-up unclear.
  • Failing to obtain or retain a clinician signature and date, which undermines verifiability.
  • Routing sensitive results without proper access controls, risking HIPAA or privacy violations.

Risks and consequences of incomplete or incorrect test records

Workplace exposure: Increased transmission risk
Regulatory fines: Citations for noncompliance
Privacy breach: HIPAA violation potential
Onboarding delays: Hires postponed
Legal claims: Employment or tort liability
Clinical errors: Misinterpreted results

Real-world scenarios where Employment TB Tests are applied

These examples illustrate common operational workflows and how the form supports compliance.

Hospital onboarding

A large hospital requires baseline screening for all clinical staff before patient contact

  • Baseline IGRA used for new hires
  • The occupational health team keeps the signed result, updates clearance flags in HR, and reports any positives to the local health department while preserving employee confidentiality.

School staff screening

A school district screens new teachers for TB as part of hiring checks

  • District policy requires documentation before classroom assignment
  • HR stores the signed test in a secure personnel file and restricts access to authorized staff only, ensuring students and staff safety.

eSignature vendor comparison relevant to Employment TB Test workflows

Comparing basic vendor capabilities and starting prices can help select a platform that supports PHI handling, bulk sends, and audit trails for TB test collection.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial Yes, 7-day trial No No Yes, limited Yes, limited
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Frequently asked questions about Employment TB Tests

Answers to common operational and legal questions when collecting, signing, and storing TB screening records.


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