TB-57, Annual Report of TB Testing in Schools
New Jersey Department of Health
Tuberculosis Program
ANNUAL REPORT OF TB TESTING IN SCHOOLS
For the Calendar Year Ending December 31, (Year)
Instructions: Numbers in the chart below are totals for newly tested individuals ONLY.
Please print or type.
No Testing Done
|County | Public School Non-Public School |
| |School Name and Address: |
| | |
|District | |
| | |
|Category |Students Born in a High TB|Students Transferring |Employees (Teachers, |Volunteers and Contractors|
| |Incidence Country entering|Directly into a NJ School |Student Teachers, Others) | |
| |a US School for the First |from a High TB Incidence | | |
| |Time |Country | | |
|TB Tests Completed | | | | |
|Significant Reactors/Positive IGRAs | | | | |
|Non-Reactors/Negative IGRAs | | | | |
|Significant Reactors/Positive IGRAs Given a Chest | | | | |
|X-Ray | | | | |
|Normal Chest X-Rays | | | | |
|Abnormal X-Rays | | | | |
|Treatment for LTBI Prescribed | | | | |
|Treatment for LTBI Not Prescribed | | | | |
|LTBI Treatment Unknown | | | | |
|Diagnosed TB Cases | | | | |
|Completed By (Print) |Email Address |Telephone Number (Incl. Ext.) |
| | |( ) Ext. |
|Signature of Superintendent or Principal |Date |
| | |
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