1.68 1.92 5.04 7.32 re Tuberculosis Screening Questionnaire: All incoming students are required to complete a TB risk Assessment Questionnaire. endstream endobj 90 0 obj <>/Subtype/Form/Type/XObject>>stream 1.68 1.92 5.04 7.32 re H�2�3U0��t.=0a�gn�`�gb�P�ʕ�e� �@�zf H�2�3U0��t.=0a�gn�`�gb�P�ʕ�e� �@�zf /Tx BMC 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.^ endstream endobj 40 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 63 0 obj <>/Subtype/Form/Type/XObject>>stream �z�F #�� 21 0 obj <> endobj �^���l,گ��. 0.84 0.84 6.72 9.48 re f 0 0 0 rg f f Prioritize persons with risks for progression . /Tx BMC /Tx BMC �z�F #�� 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. 9�6�Đ�e��r+�"�5sF_ލ�O��5�ɷg��������Q ?yR�X��t�W����|$!�h2mgg���R��R*�����Zȿ�C����|�ɯɧ�ǐ�����������G�s7����a����_��>�o��/f��U����7��s>��s>��s>mN]���2ye���d��_��Y% ;����"Ŕ��NjoZ-2�Z-b$�Z������o�O�f�����{�hّ�=��t��ѧx�-}��/�m�nzvޮ뷏^M.��귿���'O�p1Ӹ�@LG4�{r��)�C~w�?�0,}�� ��tt�(ެ�����zyƒ�8�1��ן>U�%��[�"���|U���op�~��Z��������gǏ��хn?M�`"�c�4o��@2�����W��H����˸��[��8&eV8���9ff���o2uq4�� ����҃ū"D��5 �-&����|Z�1��4�7�{b�a� 0 0 0 rg f To eliminate the threat of tuberculosis from California through leadership and the development of excellence in tuberculosis prevention and treatment. endstream endobj 112 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 47 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 103 0 obj <>/Subtype/Form/Type/XObject>>stream �z& Complete the TB Questionnaire. 0 0 0 rg f �z& 1.eplaces the mandated TB examination on initial employment with a TB risk assessment, and TB testing. 1.68 1.92 5.04 7.32 re For those at higher risk, TB testing will also be required. endstream endobj 53 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 113 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 106 0 obj <>/Subtype/Form/Type/XObject>>stream H�2�3U0��t.=0a�gn�`�gb�P�ʕ�e� �@�zf For more information and deadlines please see Tuberculosis Admission Requirement on the Student Health Services site. f /Tx BMC endstream endobj 88 0 obj <>/Subtype/Form/Type/XObject>>stream The California Department of Public Health (CDPH) Tuberculosis Risk Assessment for Child Care/School Staff and Volunteers satisfies California Education Code, … H�2�3U0��t.=0a�gn�`�gb�P�ʕ�e� �@�zf endstream endobj 80 0 obj <>/Subtype/Form/Type/XObject>>stream �z& endstream endobj 118 0 obj <>/Subtype/Form/Type/XObject>>stream EMC endstream endobj 97 0 obj <>/Subtype/Form/Type/XObject>>stream 0.84 0.84 6.72 9.48 re endstream endobj 111 0 obj <>/Subtype/Form/Type/XObject>>stream H�2�3U0��t.=0a�gn�`�gb�P�ʕ�e� �@�zf endstream endobj 44 0 obj <>/Subtype/Form/Type/XObject>>stream 0 0 0 rg 0.84 0.84 6.72 9.48 re endstream endobj 100 0 obj <>/Subtype/Form/Type/XObject>>stream Annual Mandatory TB Risk Assessment Questionnaire Question Title * 1. 0.5 0.5 0.5 rg 0 0 0 rg endstream endobj 46 0 obj <>/Subtype/Form/Type/XObject>>stream 0.84 0.84 6.72 9.48 re Evaluate for active TB disease by obtaining a chest x-ray, symptom screen, performing a physical exam and if indicated, 5 sputum testing (i.e., AFB smears, cultures and nucleic acid amplification). /Tx BMC Please begin this process early to avoid delays. H�2�3U0��t.=0a�gn�`�gb�P�ʕ�e� �@�zf 1.68 1.92 5.04 7.32 re 0.5 0.5 0.5 rg endstream endobj 122 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 92 0 obj <>/Subtype/Form/Type/XObject>>stream California Tuberculosis College and University Students Risk Assessment and User Guide (September 2019 version) (PDF) Resources Frequently Asked Questions for the United States Preventive Services Task Force Recommendations (USPSTF) on Latent Tuberculosis (TB) Screening (PDF) /Tx BMC endstream endobj 42 0 obj <>/Subtype/Form/Type/XObject>>stream 0 0 0 rg �z�F 0.84 0.84 6.72 9.48 re Students who do not show risk factors for TB as indicated by their responses on the . 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: Page 3 of 6 Assessment Summary: Please tick the appropriate TB Risk Assessment Outcomes. �z�F endstream endobj 73 0 obj <>/Subtype/Form/Type/XObject>>stream To read our latest Blog Postings click here. �z�F 0.5 0.5 0.5 rg �z�F endstream endobj 115 0 obj <>/Subtype/Form/Type/XObject>>stream LTBI testing is recommended for persons with any of the following risk factors. endstream endobj 76 0 obj <>/Subtype/Form/Type/XObject>>stream �z�F 212 0 obj <>stream �z�F 0.5 0.5 0.5 rg �z& endstream endobj 78 0 obj <>/Subtype/Form/Type/XObject>>stream EMC /Tx BMC endstream endobj 41 0 obj <>/Subtype/Form/Type/XObject>>stream �й+�,8?�1H5(7�gx���a�`[�ǠT�T| �;����A�!�!�aSs���(� endstream endobj 121 0 obj <>/Subtype/Form/Type/XObject>>stream �z�F #�� f endstream endobj 37 0 obj <>/Subtype/Form/Type/XObject>>stream 5. 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. Download Pediatric Tb Risk Assessment Questionnaire California doc. endstream endobj 50 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC H�2�3U0��t.=0a�gn�`�gb�P�ʕ�e� �@�zf 1.68 1.92 5.04 7.32 re EMC �z�F #�� /Tx BMC EMC endstream endobj 84 0 obj <>/Subtype/Form/Type/XObject>>stream f 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? endstream endobj 91 0 obj <>/Subtype/Form/Type/XObject>>stream f Complete the TB questionnaire (assessment form) Deadline July 15th. H�2�3U0��t.=0a�gn�`�gb�P�ʕ�e� �@�zf California Health and Safety Code, Section 1597.055 requires that persons hired as a teacher in a child care center must provide evidence of a current certificate that indicates freedom from infectious TB as set 1.68 1.92 5.04 7.32 re �z�F #�� f endstream endobj 48 0 obj <>/Subtype/Form/Type/XObject>>stream 1.68 1.92 5.04 7.32 re f May 16, 2019 – Changes in recommendations reflect the overall decrease of TB cases and the low incidence of TB among health care personnel due to occupational exposure. Pediatric TB Risk Assessment Questionnaire (English) Pediatric TB Risk Assessment Questionnaire (Spanish) Pediatric TB Risk Assessment: Pediatric TB Risk Assessment User Guide: TB Screening Mandates for Schools: California Management Guidelines on Childhood Lead Poisoning Nutrition Assessment What Does Your Child Eat? endstream endobj 83 0 obj <>/Subtype/Form/Type/XObject>>stream �z�F 0 0 0 rg 0.84 0.84 6.72 9.48 re H�2�3U0��t.=0a�gn�`�gb�P�ʕ�e� �@�zf endstream endobj 27 0 obj <>/Subtype/Form/Type/XObject>>stream In the private healthcare sector a child should have a TB Risk Assessment performed at every well-child visit. EMC endstream endobj 109 0 obj <>/Subtype/Form/Type/XObject>>stream 0.5 0.5 0.5 rg �z& 0 0 0 rg �z�F 0 0 0 rg f EMC H�2�3U0��t.=0a�gn�`�gb�P�ʕ�e� �@�zf �z& �z�F �z& Title: Microsoft Word - CTCA Adult TB Risk Assessment Questionnaire - EC and HSC 3-13-14.docx Created Date: 3/21/2014 3:04:57 PM %%EOF 6. endstream endobj 35 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC 0.5 0.5 0.5 rg �z�F #�� �N�[1��|��X�ʘ#rB\LG��#��퐐G/?U_h5���vΫT��_��{Tb �z�F #�� endstream endobj 108 0 obj <>/Subtype/Form/Type/XObject>>stream A: The 1st step is to complete a Tuberculosis Screening Questionnaire via the Student Health Gateway. 0.84 0.84 6.72 9.48 re 0.5 0.5 0.5 rg f Yes No Documented history of previous NEGATIVE TB test in the past 12 months If YES, attach copy of test results If NO, refer for TB test Section III: Disposition Step 1 Cough lasting 3 or more weeks plus any other symptom Step 2 Evaluation for TB Infection (TBI) Step 3 Action Needed: Step 4 Action Taken: (Check only one) Documented endstream endobj 58 0 obj <>/Subtype/Form/Type/XObject>>stream User Guide. 0.5 0.5 0.5 rg ɠq�"XP�S4�؈���XP4�� 0 0 0 rg endstream endobj 125 0 obj <>stream endstream endobj 30 0 obj <>/Subtype/Form/Type/XObject>>stream ü³èµD?äÆÉ^÷§¸Ãg¸zÑЃ€¤M-iËIZ³]I_¯^ÚF»ÈÇtm÷è. endstream endobj 114 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 62 0 obj <>/Subtype/Form/Type/XObject>>stream TB Screening Requirements for Children in Child Care. H�2�3U0��t.=0a�gn�`�gb�P�ʕ�e� �@�zf endstream endobj 75 0 obj <>/Subtype/Form/Type/XObject>>stream �z& f endstream endobj 82 0 obj <>/Subtype/Form/Type/XObject>>stream �z�F #�� �z�F #�� �z& (California Education Code, Section 49406) What specifically did : SB 792. change on September 1, 2016? �z�F #�� �z�F San Diego Tuberculosis Risk Assessment Use this tool to identify asymptomatic persons for latent TB infection (LTBI) testing. Re-testing should only be done in persons who previously tested negative, and have new risk factors since the last assessment. Select endstream endobj 96 0 obj <>/Subtype/Form/Type/XObject>>stream 1.68 1.92 5.04 7.32 re 0 0 0 rg EMC f 0.84 0.84 6.72 9.48 re endstream endobj 89 0 obj <>/Subtype/Form/Type/XObject>>stream �z& with infectious tuberculosis (TB) to prevent them from spreading TB. For people with disabilities, this document is available on request in other f To submit a request, please call 1-800-525-0127 (TDD/TTY call 711). Please see Tuberculosis Screening for Children in Childcare fact sheet for more information. Clearance for active TB attached to Risk Assessment form and returned to your Education Provider Placement Coordinator . 0.84 0.84 6.72 9.48 re endstream endobj 107 0 obj <>/Subtype/Form/Type/XObject>>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. 1.68 1.92 5.04 7.32 re A Mantoux f 0.84 0.84 6.72 9.48 re 0.5 0.5 0.5 rg �z& 0.5 0.5 0.5 rg endstream endobj 98 0 obj <>/Subtype/Form/Type/XObject>>stream California Tuberculosis Risk Assessment Pediatrics Use this tool to identify asymptomatic . f children. �z�F 1.68 1.92 5.04 7.32 re 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). endstream endobj 94 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 51 0 obj <>/Subtype/Form/Type/XObject>>stream 0 0 0 rg Employee Information. f endstream endobj 66 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC BLOG. �z�F /Tx BMC DOH 343-144 March 2019 . 0 0 0 rg /Tx BMC EMC /Tx BMC f endstream endobj 43 0 obj <>/Subtype/Form/Type/XObject>>stream 0.5 0.5 0.5 rg 0 0 0 rg endstream endobj 49 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 60 0 obj <>/Subtype/Form/Type/XObject>>stream �z& Test ONLY those with a risk for TB. endstream endobj 101 0 obj <>/Subtype/Form/Type/XObject>>stream When you in tb risk assessment questionnaire california tuberculosis risk assessment questionnaire, please read the test. �z& California Adult TB Risk Assessment. endstream endobj 57 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 55 0 obj <>/Subtype/Form/Type/XObject>>stream f �z& /Tx BMC adults Routine testing of persons without risk factors is not recommended and may result in unnecessary evaluations and treatment because of falsely positive test results. 0.84 0.84 6.72 9.48 re If YES to any questions in Part A clearance for active TB is required prior to placement . EMC f endstream endobj 79 0 obj <>/Subtype/Form/Type/XObject>>stream 0 0 0 rg EMC H�2�3U0��t.=0a�gn�`�gb�P�ʕ�e� �@�zf 0 0 0 rg 4. endstream endobj 110 0 obj <>/Subtype/Form/Type/XObject>>stream 0.5 0.5 0.5 rg Created by fys to tb risk assessment timing decision is a weakened immune system, a period of santa clara cannot attest to report. �z�F #�� Re-testing should only be done in persons who previously tested negative, and have new risk factors since the last assessment. endstream endobj 87 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 36 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 86 0 obj <>/Subtype/Form/Type/XObject>>stream �z�F #�� Take you have tb risk questionnaire, 0.5 0.5 0.5 rg f endstream endobj 28 0 obj <>/Subtype/Form/Type/XObject>>stream Recent contacts of TB case patients Persons with fibrotic changes on chest radiograph consistent with prior TB f endstream endobj 69 0 obj <>/Subtype/Form/Type/XObject>>stream 0 0 0 rg 1.68 1.92 5.04 7.32 re 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) �z�F #�� 0.5 0.5 0.5 rg 0 0 0 rg /Tx BMC /Tx BMC endstream endobj 105 0 obj <>/Subtype/Form/Type/XObject>>stream h�b``�a``e```�f@�@���qI��H�������1�0u�p;��A�fC�F� v��L 0.84 0.84 6.72 9.48 re EMC TB risk assessment. �z�F #�� f 0 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. endstream endobj 61 0 obj <>/Subtype/Form/Type/XObject>>stream 0 0 0 rg 1.68 1.92 5.04 7.32 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 your TB Risk Screening shows you to have no risks factors for TB, you should expect to receive a secure message within 7 business days confirming you are compliant with this requirement. endstream endobj 116 0 obj <>/Subtype/Form/Type/XObject>>stream 1.68 1.92 5.04 7.32 re 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.^ EMC f 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 %PDF-1.6 %���� 0.84 0.84 6.72 9.48 re OUR MISSION. 0 0 0 rg Adult Tuberculosis Risk Assessment •Use this tool to identify asymptomatic . �z& endstream endobj 123 0 obj <>/Subtype/Form/Type/XObject>>stream EMC 0.84 0.84 6.72 9.48 re H�2�3U0��t.=0a�gn�`�gb�P�ʕ�e� �@�zf Baseline Individual TB Risk Assessment pdf icon [PDF – 189 KB] Infographic: Updated Recommendations for Tuberculosis TB- Screening, Testing, and Treatment pdf icon [PDF – 308 KB] Whiteboard video: Updated TB Testing and Treatment Recommendations for Health Care Personnel media icon [MP4 – 39 MB] 0.84 0.84 6.72 9.48 re 0.5 0.5 0.5 rg endstream endobj 124 0 obj <>/Subtype/Form/Type/XObject>>stream 1.68 1.92 5.04 7.32 re �>�e�������v)���ȃ��j�I�hhD��Es���V->U?�g���z���:�y������AL����&uA������v�#��|^Uo'�������Nv�B65YGT�v���d-������òFh6��6��tu�� endstream endobj 68 0 obj <>/Subtype/Form/Type/XObject>>stream Adapted from the California Risk Assessment Tool and User Guide. 1.68 1.92 5.04 7.32 re f �z�F endstream endobj 117 0 obj <>/Subtype/Form/Type/XObject>>stream TB Screening Requirements for Child Care/School Staff and Volunteers. endstream endobj 64 0 obj <>/Subtype/Form/Type/XObject>>stream �z& �z�F 0.5 0.5 0.5 rg endstream endobj 65 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 81 0 obj <>/Subtype/Form/Type/XObject>>stream �z& endstream endobj 31 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 45 0 obj <>/Subtype/Form/Type/XObject>>stream EMC �z�F #�� 1.68 1.92 5.04 7.32 re EMC 0.5 0.5 0.5 rg Persons initially employed by a school district, or employed under contract, in a certificated or classified position (California Education Code, Section 49406) b. �z& 0.84 0.84 6.72 9.48 re endstream endobj 29 0 obj <>/Subtype/Form/Type/XObject>>stream f endstream endobj 104 0 obj <>/Subtype/Form/Type/XObject>>stream H�2�3U0��t.=0a�gn�`�gb�P�ʕ�e� �@�zf �z�F f EMC �z�F #�� endstream endobj 85 0 obj <>/Subtype/Form/Type/XObject>>stream EMC 1.68 1.92 5.04 7.32 re H�2�3U0��t.=0a�gn�`�gb�P�ʕ�e� �@�zf endstream endobj 59 0 obj <>/Subtype/Form/Type/XObject>>stream f endstream endobj 120 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC After submitting your TB screening responses, return to the “Compliance Forms” page. endstream endobj 26 0 obj <>/Subtype/Form/Type/XObject>>stream for latent TB infection (LTBI) testing. endstream endobj 39 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 67 0 obj <>/Subtype/Form/Type/XObject>>stream 1.68 1.92 5.04 7.32 re �z�F #�� endstream endobj 54 0 obj <>/Subtype/Form/Type/XObject>>stream Use of this risk assessment is required in the California Education Code, Sections 49406 and 87408.6 and the California Health and Safety Code, Sections 1597.055 and 121525, 121545, and 121555. 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. endstream endobj 102 0 obj <>/Subtype/Form/Type/XObject>>stream �z�F #�� f Avoid testing persons at low risk. endstream endobj 38 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC �z& f endstream endobj 52 0 obj <>/Subtype/Form/Type/XObject>>stream 0.84 0.84 6.72 9.48 re f �z�F f f H�2�3U0��t.=0a�gn�`�gb�P�ʕ�e� �@�zf �z& Today's Date. H�2�3U0��t.=0a�gn�`�gb�P�ʕ�e� �@�zf 0.84 0.84 6.72 9.48 re Instructions Page for Pediatric TB Risk Assessment revised 10/2016 The Pediatric Tuberculosis (TB) Risk Assessment should be performed at first contact with a child, then at 6 months, 1 year of age and every year thereafter. 0.84 0.84 6.72 9.48 re 0.84 0.84 6.72 9.48 re endstream endobj startxref EMC endstream endobj 56 0 obj <>/Subtype/Form/Type/XObject>>stream All incoming students are required to complete a TB Risk Screening Questionnaire. f 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.^ After 2 years of age, risk assessment for tuberculosis should be performed annually. the Pediatric Tuberculosis Study Group of Kaiser Permanente, Northern California ABSTRACT. Objective. ÷È+XٗÐ+”@dláwÒ¡f£`­…­K€¸Š à Ú f endstream endobj 71 0 obj <>/Subtype/Form/Type/XObject>>stream �z�F �z�F #�� endstream endobj 33 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 95 0 obj <>/Subtype/Form/Type/XObject>>stream f Date Date Question Title * 2. 0.5 0.5 0.5 rg endstream endobj 32 0 obj <>/Subtype/Form/Type/XObject>>stream 1.68 1.92 5.04 7.32 re �z�F 1.68 1.92 5.04 7.32 re EMC /Tx BMC H�2�3U0��t.=0a�gn�`�gb�P�ʕ�e� �@�zf R based on the results of the TB risk assessment, for the following groups: a. The law requires that a health care provider administer this risk assessment. EMC A TB risk assessment is not used for screening people who have documented history of a positive TB test or TB disease. endstream endobj 70 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 93 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC f High Risk Tuberculosis Screening Questionnaire are not required to complete/submit a TB Health Assessment Form. |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{ H�2�3U0��t.=0a�gn�`�gb�P�ʕ�e� �@�zf �z�F f EMC �����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�� 0.5 0.5 0.5 rg 0.5 0.5 0.5 rg endstream endobj 77 0 obj <>/Subtype/Form/Type/XObject>>stream Risk Assessment Check the appropriate risk factor boxes below. endstream endobj 72 0 obj <>/Subtype/Form/Type/XObject>>stream Complete the Immunization Requirements endstream endobj 25 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 99 0 obj <>/Subtype/Form/Type/XObject>>stream H�2�3U0��t.=0a�gn�`�gb�P�ʕ�e� �@�zf �z�F �z�F #�� endstream endobj 119 0 obj <>/Subtype/Form/Type/XObject>>stream f 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 h��{�o�H����3�7&��Xp�d'�3�`���^.8(6�+K^I���_��S�MR�d˱��Y����lV7���iec�Tʦ�БrM�C�_UE�Օj��S)��Rk�W)oq�(�D�ҍ��\����ХJ[��M�=?�*��]�&Qco*��Eg�=������f�+��P٦��XYŏ����:�Te8�����`*��R;gq\��-_� ~h�.Y�0��+MC���Ds�qMJā�|J4�TA7hc�`i(*�*�+� California School Employee Tuberculosis (TB) Risk Assessment Questionnaire 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. endstream endobj 74 0 obj <>/Subtype/Form/Type/XObject>>stream endstream endobj 34 0 obj <>/Subtype/Form/Type/XObject>>stream Higher risk, TB testing will also be required are required to complete a risk. 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