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  1. Results. * It is very unlikely that a side effect to the test will occur. If such an event does happen, the most common reaction is pain or redness at the test site. In very rare cases, a person who is hypersensitive to the solution could have a severe allergic reaction near the injection site. Such rare reactions may include blistering or a ...

  2. Find professionally drafted PPD forms and templates. Simplify the process of Tuberculosis risk assessment with our customizable PPD form.

  3. To determine if a skin test should be administered, conduct a risk assessment for each patient that takes into consideration recent exposure to TB disease, clinical conditions that increase the risk for TB disease if infected, and the program’s capacity to deliver treatment for latent TB infection. Locate and clean injection site.

  4. Step 1: Do an initial tuberculin skin test (Mantoux, 5 TU PPD). Read results 48-72 hours later. Step 2: If the results from Step 1 is 0-9mm of induration: Do a second tuberculin skin test in the other arm 7 to 21 days after Step 1.

  5. TUBERCULIN SKIN TEST FORM (also called TB or PPD) TO BE FILLED OUT BY THE STUDENT. TO BE FILLED OUT BY THE HEALTHCARE PROVIDER. *Please note that a positive result requires a chest x-ray.

  6. For previous POSITIVE Tuberculin Skin Test, complete the section at the bottom of page. ... TWO STEP TUBERCULIN SKIN TEST FORM Print Name _____ Date of Birth _____ Signature _____ Date _____ ... TB Screening Form – Please indicate if you have any of the following symptoms:

  7. The TUBERCULOSIS SKIN TEST is a way of identifying TB infection. You cannot get TB from the skin test. Health care workers are required to be screened regularly for TB. SIDE EFFECTS: If you have been exposed to TB in the past, swelling and redness may develop at the site of the test. A blister or scar may also result.

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