Follow the steps to complete the form effectively.

1. Click 'Get Form' button to obtain the form and access it in an editable format.
2. Begin by filling out the applicant's name and employee number or social security number in the designated fields. This information is critical for processing your submission.
3. Select the type of tuberculosis test you have undergone. This may include options for the Quantiferon/IGRA test or the Tine skin test; ensure to mark only valid choices as specified.
4. If applicable, enter the date the chest X-ray was taken, following the instruction for inclusion of the chest X-ray results. Remember, only submit this if you have a history of a positive skin or blood test.
5. Provide the test date and collection date for the tuberculosis test. Fill these fields accurately for consistent record-keeping.
6. Include the name and license number of the medical doctor or osteopath who administered the test. This assures validity of the results.
7. Document the result of the test, specifying the induration measurement (in millimeters) and indicating whether it is positive.
8. Obtain the medical office stamp and signature from your healthcare provider to finalize the document. These are required for acceptance of the form.
9. Review all entries for accuracy and completeness before submission. Ensure no fields are left blank, as incomplete forms will not be accepted.
10. Once you have filled out the form, save your changes. You may choose to download, print, or share the document as needed for your records or submissions.

Complete your documents online today to ensure compliance and a smooth application process.