Tuberculosis Screening and Targeted Testing

If the answer is YES to any of the following questions, Drury University requires that a healthcare provider complete a TB risk assessment as a condition of employment.

If the answer to all of the following questions is NO, then no further testing or actions are required.

Have you had a positive TB skin test? Yes   No
Have you ever had close contact with persons known or suspected to have active TB disease? Yes   No
Were you born in one of the countries listed below that have a high incidence of active TB disease?
If yes, please check the appropriate country.
Yes   No
Afghanistan
Algeria
Angola
Argentina
Armenia
Azerbaijan
Bahrain
Bangladesh
Belarus
Belize
Benin
Bhutan
Bolivia
Bosnia & Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Central African Republic
Chad
China
Colombia
Comoros
Congo
Cote D'Ivoire
Croatia
Democratic People's Republic of Korea
Democratic Republic of the Congo
Djibouti
Dominican Republic
Ecuador
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Gabon
Gambia
Georgia
Ghana
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
India
Indonesia
Iraq
Japan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lesotho
Liberia
Libyan Arab Jamahiriya
Lithuania
Madagascar
Malaysia
Malawi
Maldives
Mali
Marshall Islands
Mauritania
Mauritius
Micronesia
Mongolia
Morocco
Mozambique
Myanmar
Nambia
Nepal
Nicaragua
Niger
Nigeria
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Republic of Moldova
Romania
Russia
Rwanda
St Vincent & Grenadines
Sao Tome & Principe
Senegal
Seychelles
Sierra Leone
Singapore
Solomon Islands
Somalia
South Africa
Sri Lanka
Sudan
Suriname
Swaziland
Syrian Arab Republic
Tajikistan
Thailand
The Former Yugoslav Republic of Macedonia
Timor-Leste
Togo
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Source: World Health Organization Global Health Observatory, Tuberculosis Incidence 2010. Countries with incidence rates of > 20 cases per 100,000 population. For further updates refer to http://apps.who.int/ghodata
 
Have you had frequent or prolonged visits* to one or more of the countries listed below with a high prevalence of TB disease?   Yes   No
If yes, please check the applicable countries below.
Afghanistan
Algeria
Angola
Argentina
Armenia
Azerbaijan
Bahrain
Bangladesh
Belarus
Belize
Benin
Bhutan
Bolivia
Bosnia & Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Central African Republic
Chad
China
Colombia
Comoros
Congo
Cote D'Ivoire
Croatia
Democratic People's Republic of Korea
Democratic Republic of the Congo
Djibouti
Dominican Republic
Ecuador
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Gabon
Gambia
Georgia
Ghana
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
India
Indonesia
Iraq
Japan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lesotho
Liberia
Libyan Arab Jamahiriya
Lithuania
Madagascar
Malaysia
Malawi
Maldives
Mali
Marshall Islands
Mauritania
Mauritius
Micronesia
Mongolia
Morocco
Mozambique
Myanmar
Nambia
Nepal
Nicaragua
Niger
Nigeria
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Republic of Moldova
Romania
Russia
Rwanda
St Vincent & Grenadines
Sao Tome & Principe
Senegal
Seychelles
Sierra Leone
Singapore
Solomon Islands
Somalia
South Africa
Sri Lanka
Sudan
Suriname
Swaziland
Syrian Arab Republic
Tajikistan
Thailand
The Former Yugoslav Republic of Macedonia
Timor-Leste
Togo
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
 
Have you ever been vaccinated with BCG? Yes   No
 
Have you ever been a resident of and/or employee of high-risk congregate settings (e.g. correctional facilities, long-term care facilities, and homeless shelters)?
Yes   No
 
Have you been a volunteer or health-care worker who served clients who are at increased risk for active TB disease?
Yes   No
 
Have you ever been a member of any of the following groups that may have an increased incidence of latent M. tuberculosis infection or active TB disease
Groups: Medically undeserved, low-income, or abusing drugs or alochol?
Yes   No
 
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