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Careers
Home
Courses
CNA Classes
Med Tech Class
CPR Classes
Course Calendar
APPLY!
CNA Program Application
MedTech Registration Form
Upload Registration Documents
Work Exchange Application
CPR Individual Registration Form
CPR Group Registration Form
Contact Us
Careers
TB Screening
Name
(Required)
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
Employer/Agency Name
(Required)
Have you been exposed to anyone with TB in the last year?
(Required)
Yes
No
Have you ever been treated for TB?
(Required)
Yes
No
When were you treated for TB?
Have you had a persistent cough in the last 6 month??
(Required)
Yes
No
Have you had hoarseness in the last 6 month??
(Required)
Yes
No
Have you had excessive weight loss in the last 6 month??
(Required)
Yes
No
Have you had excessive sweating at night in the last 6 month??
(Required)
Yes
No
Have you coughed up blood in the last 6 month??
(Required)
Yes
No
Have you had persistent fever in the last 6 month??
(Required)
Yes
No
Screening Process
If you answered yes to any of these questions, a nurse with SembraNet will call you to complete your screening process.
