2018-2019 School TB Screening Results - Please contact the TB Program at 269-8000 if you have problems or questions.

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* 1. School Name

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* 2. School Address

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* 3. School Telephone Number

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* 4. Name of School Principal/Director

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* 5. Name of Person Completing this Survey

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* 6. What kind of TB risk school are you reporting for?

A high-risk school

A low-risk school

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* 7. Email address of person completing report:

Your email address will be used to send a confirmation of receipt of your report. Confirmation emails will be sent weekly; they will not contain a copy of your answers.