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Last Updated: Nov 13, 2026
Practice Management Tips
TB risk assessment form: questions, CDC rules and a template
Free PDF 1 page, print-ready Clinician-reviewed
A TB risk assessment form is a short clinical questionnaire that decides whether a patient needs a tuberculosis test, before any test is ordered. It asks about exposure, symptoms, travel, and risk factors, so clinicians can sort patients into no test, a TST or IGRA, or prompt referral. The downloadable PDF is a general health risk assessment template, not a ready-made TB screening form. Your team adapts it with the TB questions from the table in this guide, using your state's wording.
Template details
- Template type
- Assessment
- Format
- Printable PDF, 1 page
- Fields to complete
- 12 fields
- Best for
- Practice Management Tips
Free download
Download your free health risk assessment form template
A blank health risk assessment template with sections for visit details, medical history, preventive services, assessment and plan, and patient education. Add your TB screening questions before use.
What’s inside
- Date field and an open box for visit details
- Blank health risk assessment section, ready for your TB screening questions
- Free-text medical history section for conditions, prior tests and treatment
- Preventive services section for the screenings and tests offered
- Assessment and plan section for the risk category and next step
- Patient education and counseling section for advice given
Generate it. Send it. File it automatically.
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Key takeaways
A TB risk assessment form decides whether a patient needs a TB test, not whether they have TB.
CDC guidance centers the form on exposure history, symptoms, and risk factors such as travel and immunosuppression.
Latent TB infection is identified only by a TST or IGRA result plus clinical evaluation, never by the form alone.
The downloadable PDF is a general health risk assessment template, so your team adds the TB questions before use.
Healthcare workers, new patients, and certain school and employment entrants are the groups most often screened.
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What is a TB risk assessment form?
A TB risk assessment form is a structured questionnaire that clinicians use to sort patients by their likelihood of tuberculosis infection. CDC’s clinical testing guidance targets testing at people with increased risk and discourages any testing approach that skips a risk assessment. A positive answer signals that a test is needed, and it says nothing yet about active TB.
Public health departments and occupational health teams use the same logic. The form captures what a clinician needs to choose between no further action, a tuberculin skin test (TST), or an interferon-gamma release assay (IGRA). A positive assessment leads to a TST or IGRA. Latent TB infection is identified only by that test result plus clinical evaluation.
Questions the form should ask
Most TB risk assessment forms group their questions into a few clear categories. Each one maps to a specific clinical decision.
Clinicians use the answers to categorize risk, not to make a diagnosis. The CDC lists three core risk factors for latent TB infection. They are birth in or travel to a high-burden country, close contact with active TB, and immunocompromising conditions.
What the downloadable template covers, and how to adapt it
The PDF is a general health risk assessment template, not a ready-made TB screening form. It has six blank sections: visit details, health risk assessment, medical history, preventive services, assessment and plan, and patient education and counseling. Your team adds the TB questions from the table above before the first patient fills it in.
Each question category fits one of the existing sections:
- Health risk assessment: country of birth, travel, residence history, and close contact with active TB
- Medical history: immunocompromising conditions, prior TB infection, earlier test results, and past treatment
- Visit details: the symptom screen, so a positive answer is seen before anything else
- Assessment and plan: the risk category and the next step, whether no test, a TST or IGRA, or referral
- Patient education and counseling: what the next step means and when results come back
Prefer a form with the TB questions already written? The TB skin test questionnaire includes exposure, risk factor, and symptom sections alongside the test record. For a wider annual wellness intake, the health risk assessment questionnaire covers the CMS-required domains.
CDC screening guidance: what the form must cover
The CDC’s TB guidance is risk-based. The 2019 NTCA/CDC recommendations for screening health care personnel moved away from universal annual testing for low-risk staff. The form now needs to establish individual risk rather than default to a test. At a minimum, it should record:
- Exposure history, including contact with a known or suspected active TB case
- Symptom screening for active TB, such as persistent cough and night sweats
- Risk factors for progression, including HIV and other immunocompromising conditions
- Travel and country-of-birth information relevant to TB prevalence
Read the current guidance directly from the CDC’s tuberculosis resources before finalizing any local version. Protocols and test preferences change, so check the publication date on every source.
Who completes the form?
Completion depends on the setting. Most practices use the form at new patient intake, while occupational health teams apply it to staff. These are the groups most often screened:
- New patients, particularly those born in or recently traveled to high-burden countries
- Healthcare workers, screened on a risk basis at hire and as local policy requires
- School or employment entrants where a local requirement applies
- Immunocompromised patients and those with close contact to active TB
Whether a school or employer requires the form depends on state and local rules. Confirm the requirement with the relevant public health department before assuming it applies.
Screening healthcare workers
For healthcare workers, the form sits inside an infection control program. Baseline screening at hire combines a risk assessment, a symptom evaluation, and a TB test. After that, each staff member’s exposure risk and role decide whether more testing is needed.
Occupational health teams usually file the completed form with the staff member’s immunization record and test history. Employer obligations also sit within OSHA requirements, so confirm local compliance rules with your occupational health provider.
Screening children vs. adults
Pediatric screening follows age-appropriate criteria, and clinicians adapt the questions accordingly. Confirm the protocol your local TB program specifies for children before using an adult version.
State-specific forms: California and beyond
State TB programs set their own forms, so a California form will not always match the one used in another state. California’s TB requirement for K-12 school employees starts with a risk assessment, and only staff whose answers show risk factors go on to testing. That variation makes the local version worth checking.
- Use the official form published by your state or county public health department
- Check whether your setting (school, employer, practice) has its own requirement
- Record the publication date of the version you use
Reading the results
A completed form leads to one of three outcomes: no further action, a TB test, or referral. The clinician decides based on the answers, and the form does not replace clinical judgment.
A positive risk assessment confirms only that testing is needed. The diagram traces where each path ends, and diagnosis sits at the end of the testing path alone.
How Pabau runs TB screening before the visit
Paper TB forms get completed at the front desk, filed, and pulled again when a test result comes back. Each handoff is a chance for an unanswered exposure question to go unnoticed.
Pabau, the GP clinic software we build for primary care, sends the questionnaire ahead of the appointment through its digital forms. Patients answer on their phone, and the responses land on their patient record.
Your team builds the TB questions into the form once, in your state’s wording. Clinicians then review exposure history and risk factors next to the visit notes. The choice between no test, a TST or IGRA, or referral happens at the point of care.
Collect TB screening answers before the visit
Pabau’s digital forms send your TB risk assessment ahead of the appointment and file every answer on the patient record. Clinicians see the risk factors before they decide on a TST or IGRA.
Conclusion
Treat the TB risk assessment as a sorting step with three clear exits. Low-risk patients without symptoms need no test, patients with risk factors get a TST or IGRA, and symptoms mean prompt referral.
The downloadable template gives you the structure, but the TB questions are yours to add. Write them against your state’s form and the CDC’s risk factors before the first patient sees it. A form built that way holds up when a test result needs explaining.
Book a demo to see how Pabau sends your TB questionnaire before the visit and files every answer with the patient record.
Continue your research
Need the TB questions already written? TB skin test questionnaire covers exposure, risk factors, symptoms, and the test record in one form.
Running annual wellness visits? Health risk assessment questionnaire covers the CMS-required domains for a full risk review.
Tracking staff and patient vaccines? Immunization record form logs dates, doses, lot numbers, and titer results.
Deciding which screenings to offer by age? Health screening tests lists what to check and when.
Building a new patient intake? General practice intake form gathers history, medications, and allergies before the first visit.
Frequently asked questions
What is a TB risk assessment form?
A TB risk assessment form is a screening questionnaire that determines whether a patient needs a tuberculosis test. It captures exposure, symptoms, travel, and risk factors before any testing decision is made.
Who needs to complete a TB risk assessment?
New patients, healthcare workers, and some school or employment entrants may be asked to complete one. Whether it is required depends on local and state rules.
Is a TB risk assessment the same as a TB test?
No. The risk assessment is the screening step that decides whether a test is needed. A test result, together with clinical evaluation, is what supports a diagnosis.
Do healthcare workers need annual TB risk assessments?
Not always. The CDC’s 2019 guidance moved away from a universal annual requirement toward a risk-based approach, so frequency depends on exposure risk and local policy.
What happens if a TB risk assessment is positive?
A positive result usually leads to a TB test, such as a TST or IGRA, and clinical review. It does not confirm infection by itself.
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