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Appendix B. Tuberculosis (TB) risk assessment …

_____ _____ _____ _____ _____ _____ 09/27/2006 centers for disease control and prevention Division of Tuberculosis Elimination Appendix B. Tuberculosis (TB) risk assessment worksheet This model worksheet should be considered for use in performing TB risk assessments for health-care facilities and nontraditional facility-based settings. Facilities with more than one type of setting will need to apply this table to each setting. Scoring or Y = Yes X or N = No NA = Not Applicable 1. Incidence of TB What is the incidence of TB in your community (county or region served by Community rate_____ the health-care setting), and how does it compare with the state and national State rate _____ average?

09/27/2006 Centers for Disease Control and Prevention Division of Tuberculosis Elimination Appendix B. Tuberculosis (TB) risk assessment worksheet

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