Get Staff Health Report

This guide provides clear instructions on how to effectively complete the Staff Health Report for licensed child care centers. Following these steps will ensure that all necessary information is accurately submitted online, complying with regulatory requirements.

Follow the steps to fill out the Staff Health Report online.

1. To obtain the form, click the ‘Get Form’ button to access the document in your preferred online editor.
2. In Section A, staff information must be filled out. Enter the individual's name (last, first, middle initial) and their position title. Ensure this information is accurate to prevent delays.
3. Proceed to Section B for the tuberculosis test information. Indicate the type of test conducted (Mantoux Tuberculin Skin Test or QuantiFERON Blood Assay) and the date of the test in mm/dd/yyyy format.
4. Next, identify the risk classification by selecting the appropriate option: Low risk, Medium risk, or Potential ongoing transmission. Additionally, measure the size of the induration and mark the correct millimeter measurement.
5. Specify the results of the TB test by checking either Positive or Negative. If the test results are positive, indicate whether a follow-up medical evaluation and chest X-ray were completed.
6. Sign the form in Section B as the health professional who conducted the examination. Include your address and print your name along with the date signed.
7. Moving on to Section C, certify whether the individual appears free of symptoms of illness and whether they are physically able to work with children. Check 'Yes' or 'No' as applicable.
8. Provide any comments if necessary, then sign as the examining health professional, again including your office address, printed name, and date signed.
9. After completing all sections, ensure to review the form for accuracy. You can then save changes, download, print, or share the form as needed.

Complete the Staff Health Report online to ensure compliance and support child care operations.