San Diego Tb Test Form PDF Details

In the heart of ensuring a healthy and secure environment for both students and volunteers within its educational establishments, the San Diego Unified School District mandates a comprehensive tuberculosis screening process for all its volunteers. This rigorous procedure is encapsulated in the San Diego Tb Test Form, a key document that volunteers must accurately fill out and submit. The form requires detailed information, including the volunteer's name, date of birth, usual volunteer location, home address, and contact details, ensuring a clear identification and traceability of each volunteer's health status. With an intradermal tuberculin test at its core, the form serves not only as a record of the test administered but also highlights the importance of a 48-72 hour reading post-administration. A crucial aspect of this form is the certification of tuberculosis examination by a licensed physician and surgeon, confirming the volunteer's condition as free from active tuberculosis. This certification is vital for the continuation of the volunteer's service within the school district, emphasizing the district's commitment to public health and safety. By requiring a signature from both the examining physician or surgeon and the school nurse, the form attests to the thoroughness of the health screening process, ensuring that all volunteers engage in their roles without posing health risks to themselves or others. This carefully structured process underscores the district's dedication to maintaining a safe educational environment, leveraging health documentation to prevent the spread of tuberculosis within its community.

QuestionAnswer
Form NameSan Diego Tb Test Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesTUBERCULOSIS, INTRADERMAL, san diego tuberculin card, san diego district tuberculin card

Form Preview Example

San Diego Unified School District

VOLUNTEER TUBERCULIN TEST CARD

LAST NAME

FIRST NAME

INITIAL

DATE OF BIRTH

USUAL VOLUNTEER LOCATION (School)

HOME ADDRESS (NUMBER AND STREET)

CITY

ZIP

PHONE NO.

INTRADERMAL TUBERCULIN TEST - VOLUNTEER

Be sure this certificate is filed with the Volunteer Coordinator at your school.

Failure to comply with this requirement will prevent your continual volunteer service with the District.

CERTIFICATE OF TUBERCULOSIS EXAMINATION

48-72 hour reading of intradermal tuberculin test was: Positive Negative

Date of skin test ________________________________________________________

Date read ____________________________Induration ______________________m.m

CERTIFICATE OF TUBERCULOSIS EXAMINATION

I certify that I am a physician and surgeon licensed under Chapter 5 of Division 2 of the Business and Professional Code of the State of California; that I have examined the results of an intradermal tuberculin test and/or an x-ray of the lungs of the above-named person, and I have found him/her free from active tuberculosis.

_______________________________________________ _____________________

_______________________________________________

__________________

Physician and Surgeon

Date

School Nurse

Date

NOT VALID IF UNSIGNED BY PHYSICIAN