HEAD START VOLUNTEER - TB SCREENING AND TESTING
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HEAD START VOLUNTEER - TB SCREENING AND TESTING
To protect our children, Head Start requests that all regular volunteers be screened for tuberculosis. A regular volunteer is defined as a person who volunteers in the Head Start classroom more than one time per month.
HIGH RISK CRITERIA FOR TUBERCULOSIS
1. A person exhibiting symptoms of TB (cough, cough with bleeding, weight loss, etc.) and/or laboratory findings that suggest TB.
2. A person having recent contact with someone known or suspected to have clinically active TB.
3. A person with HIV infection.
4. A person with abnormal chest x-rays suggesting past TB.
5. A person with other medical conditions that increase the risk of TB. (rapid weight loss, end-stage renal disease, diabetes mellitus, injecting drug use, prolonged corticosteroid therapy, etc.)
6. A person from a high risk group for recent infections with M. tuberculosis, such as immigrants from Asia, Africa, Latin American, and Oceania; and medically underserved populations.
Please check and sign one of the statements below.
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I have read the High Risk Criteria for Tuberculosis and would not be considered at risk. For personal or medical reasons I choose not to obtain a TB test at this time.
Signature: ____________________________________
Date: ____________________________________
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I understand that I need to obtain this documentation before volunteering in the Head Start classroom.
Signature: ____________________________________
Date: ____________________________________
Medical Provider of TB test: ____________________________________
(a separate release must be signed if you wish us to obtain these results directly from your physician)
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*Head Start will pay for TB screening for Head Start parents who are regular volunteers and have no other medical payment source.