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Tuberculosis Screening/Update
This form is for students who need to correct/update admissions application tuberculosis (TB) related questions which they feel they answered incorrectly. Jefferson College TB Policy is required per Senate Bill 197,
Missouri Revised StatuesÂ
Section 199.290.
If you answer yes to any questions below, you will need to submit the
TB Health Assessment
form before registering for your second semester at Jefferson College.
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* Indicates required question
When answering questions, refer to the following list of countries and territories with a high incidence of active TB disease.
Student ID# (V00xxxxxx)
*
Your answer
Student Last Name
*
Your answer
Student First Name
*
Your answer
Jefferson College Email Address (@jeffco.edu)
*
Your answer
Have you ever had close contact with persons known or suspected to have active TB disease?
*
Yes
No
Were you born in any of the countries or territories listed above with a high incidence of active TB disease?
Yes
No
Clear selection
Have you had frequent or prolonged visits in any of the countries or territories listed above with a high incidence of act TB disease?
*
Yes
No
Have you been an employee and/or resident of a high risk congregate setting (e.g. correctional facilities, long term care facilities, and homeless shelters)?
*
Yes
No
Have you been a volunteer or health care worker who served clients who are at increased risk for active TB disease?
*
Yes
No
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