This form is used to support tuberculosis (TB) risk assessment and occupational health screening. It collects information about TB history, screening results, and relevant occupational health requirements.
All workers and students need to submit this form to their NSW health agency or education provider.
Education providers must forward this form to the NSW Health agency for assessment.
The NSW Health agency will assess this form and determine whether TB screening or TB clinical review is required.
Refer to NSW TB Services contact details for more information.
Personal information about students and employees collected by NSW Health is handled in accordance with the Health Records and Information Privacy Act 2002.
NSW Health is collecting your personal information to meet its obligations to protect the public and to provide a safe workplace as per the current Occupational Assessment Screening and Vaccination Against Specified Infectious Diseases Policy Directive.
All personal information will be securely stored, and reasonable steps will be taken to keep it accurate, complete and up to date.
Personal information recorded on this form will not be disclosed to NSW Health officers or third parties unless the disclosure is authorised or required by or under law.
If you choose not to provide your personal information, you will not meet the condition of placement.
For further information about how NSW Health protects your personal information, or to learn about your right to access your own personal information, please see our website at www.health.nsw.gov.au
