New Jersey Department of Health Tuberculosis Program ANNUAL REPORT OF TB TESTING IN SCHOOLS For the Calendar Year Ending December 31, (Year) Instructions: Numbers in the chart below are totals for newly tested individuals ONLY. Please print or type. No Testing Done County Public School Non-Public School School Name and Address: District Students Students Born in a Transferring High TB Incidence Employees Directly into a NJ Volunteers and Category Country entering a (Teachers, Student School from a High Contractors US School for the Teachers, Others) TB Incidence First Time Country TB Tests Completed Significant Reactors/Positive IGRAs Non-Reactors/Negative IGRAs Significant Reactors/Positive IGRAs Given a Chest X-Ray Normal Chest X-Rays Abnormal X-Rays Treatment for LTBI Prescribed Treatment for LTBI Not Prescribed LTBI Treatment Unknown Diagnosed TB Cases Completed By (Print) Email Address Telephone Number (Incl. Ext.) ( ) Ext. Signature of Superintendent or Principal Date
New Jersey Department of Health Tuberculosis Program ANNUAL REPORT OF TB TESTING IN SCHOOLS For the Calendar Year Ending December 31, (Year) Instructions: Numbers in the chart below are totals for newly tested individuals ONLY. Please print or type. No Testing Done County Public School Non-Public School School Name and Address: District Category Students Born in a High TB Incidence Country entering a US School for the First Time Students Transferring Directly into a NJ School from a High TB Incidence Country Employees (Teachers, Student Teachers, Others) Volunteers and Contractors TB Tests Completed Significant Reactors/Positive IGRAs Non-Reactors/Negative IGRAs Significant Reactors/Positive IGRAs Given a Chest X-Ray Normal Chest X-Rays Abnormal X-Rays Treatment for LTBI Prescribed Treatment for LTBI Not Prescribed LTBI Treatment Unknown Diagnosed TB Cases Completed By (Print) Email Address Telephone Number (Incl. Ext.) ( ) Ext. Signature of Superintendent or Principal Date
TB%20Annual%20Report%20of%20TB%20Testing%20in%20Schools.docx