How to Complete Texas DSHS TB Screening and Questionnaire Forms

The Texas DSHS TB screening form you need depends on the setting requiring the screening. Individuals being personally screened as adults usually complete the TB-501 (Adult Tuberculosis Signs and Symptoms Screening Questionnaire) or the shorter TB-810 (Tuberculosis Symptom Screening Form). Facilities classifying their overall risk use the TB-500 (Congregate Settings Tuberculosis Risk Assessment). All are posted on the DSHS TB Forms and Resources page.¹ Many Texas employers and universities skip the DSHS forms entirely and use their own questionnaires, so your first move is to ask the office that told you to get screened which form they want.

Which Form Applies to Your Situation

Texas Health and Safety Code Chapter 81 gives local health authorities broad power to require screening, and specific rules layer on top of that for certain workers and students.² The setting you fall into determines which paperwork you complete.

Correctional Facility Employees, Volunteers, and Inmates

Chapter 89 applies to Texas Department of Criminal Justice facilities, municipal and county jails, and juvenile justice facilities.³ Employees, volunteers, and inmates who meet the screening guidelines must obtain a certificate from a physician stating they tested negative for TB.⁴ The implementing rule at 25 Texas Administrative Code § 97.173 says results should be recorded on a certificate or similar document, with the recommended format being the Tuberculosis Record described in § 97.179. If you already have a history of a positive skin test, you must provide documentation of that test plus any follow-up, signed by a physician or registered nurse.⁵

Child-Care Center Workers

Child-care center minimum standards require each employee’s personnel file to include a health card or a healthcare professional’s statement verifying the employee is free of active TB, but only if the regional DSHS TB program or local health authority requires it in that area.⁶ The same conditional rule applies to children in care.⁷ Call the TB manager at your nearest DSHS regional office if you are not sure whether your county falls under this requirement.

Healthcare Workers

Healthcare personnel should be screened at the time of hire. The CDC recommends a baseline risk assessment, symptom evaluation, and either a TB blood test or skin test as part of preplacement screening.⁸ Texas healthcare employers set their own timelines and forms, generally following CDC guidance. Ask employee health for the exact document.

International College Students

Most Texas universities require international students to complete a TB screening questionnaire before registering for classes, and most use their own online systems rather than a DSHS form. UT Austin’s international students complete an online questionnaire through the Med+Proctor portal; if the questionnaire flags a need for testing, the test must be performed in the United States within six months before the first day of classes. Only the QuantiFERON-TB Gold or the T-SPOT is accepted, and a chest X-ray alone is not a substitute.⁹ UT Dallas places a hold on student accounts until the screening is complete, and students who skip it cannot attend classes.¹⁰ Check your own university’s health portal for its specific form and deadline.

What Each DSHS TB Form Covers

The DSHS TB Forms and Resources page hosts the screening, reporting, and case management forms used across Texas.¹ Four are relevant to screening:

TB-500, Congregate Settings Tuberculosis Risk Assessment. A facility-level form that classifies a jail, shelter, or long-term care facility as high, medium, or low risk based on recent TB test conversions, county incidence rates, and whether the facility serves people from countries with elevated TB rates. Individuals do not fill this out.¹¹
TB-501, Adult Tuberculosis Signs and Symptoms Screening Questionnaire. An individual-level questionnaire covering symptoms and risk factors. This is the form most adults are asked to complete when their employer or a facility requires a personal TB screening.
TB-810, Tuberculosis Symptom Screening Form. A shorter symptom-focused form.¹²
TB-400A and TB-400B, Report of Case and Patient Services. Case management forms used by providers and public health staff to report confirmed TB cases. Not something a patient fills out.

If your university, hospital, or employer hands you a form of their own, use that one. The DSHS forms matter most when a local health authority, jail, or congregate setting is directing the screening.

Filling Out the Questionnaire

Whichever form you use, Texas TB screening questionnaires cover the same ground: identification, symptoms, and risk factors. Start with your name, date of birth, and contact information. Then work through the two substantive sections.

Symptom Section

You will be asked whether you have experienced symptoms consistent with active TB disease. These typically include a cough lasting longer than two to three weeks, unexplained weight loss, night sweats, fever, fatigue, and coughing up blood. Answer honestly. Checking “yes” to any symptom routes you toward a medical evaluation rather than a simple screening test.

Risk-Factor Section

The risk-factor questions ask about exposure history and background: whether you have spent time in a country where TB is widespread, whether you have had close contact with someone diagnosed with active TB, whether you live or work in a congregate setting such as a shelter, jail, or nursing home, and whether you have a medical condition that weakens the immune system, such as HIV, diabetes, or an organ transplant. The CDC does not publish a single list of countries that automatically triggers screening; it points instead to the WHO’s Global Tuberculosis Programme reports and notes that parts of Asia, Africa, and Latin America fall into the elevated-risk category.¹³

For the facility-level TB-500, the risk-factor questions are institutional rather than personal, covering recent test conversions among staff, the county’s incidence rate relative to the state rate, and whether the facility houses people who emigrated from high-TB-rate countries within the past five years.¹¹

If every symptom and risk-factor answer is negative, many institutions accept the completed questionnaire as sufficient documentation, and no testing follows. A “yes” anywhere moves you to the testing stage.

If the Questionnaire Sends You for a Test

Two screening tests are used in Texas: the tuberculin skin test (TST) and the interferon gamma release assay (IGRA) blood test.¹⁴

With the skin test, a provider injects purified protein derivative under the skin of your forearm and you return two to three days later to have the reaction read in millimeters of induration. Two visits are required, and missing the reading appointment means starting over.⁵ The IGRA is a single blood draw at a lab; the FDA-approved versions are the QuantiFERON-TB Gold and the T-SPOT.⁹ Without insurance, a skin test generally runs $40 to $75; an IGRA falls in the $100 to $350 range. University health centers and local health departments sometimes offer lower-cost or free testing.

A positive result does not mean you are sick or contagious. Most positives indicate latent TB infection, meaning the bacteria are present but dormant, with no symptoms and no ability to spread the disease. Roughly 5 to 10 percent of people with untreated latent TB will develop active disease at some point, about half of those within the first two years, and the risk climbs sharply with a weakened immune system. A positive test is usually followed by a chest X-ray and possibly a sputum culture to sort latent from active disease. Latent TB with a normal chest X-ray typically clears you to work or attend classes, sometimes on a treatment plan; active disease requires treatment and confirmation you are no longer infectious.

Where to Submit the Completed Form

Submission depends on who required the screening.

University students upload the completed questionnaire and any lab results to a secure health portal. UT Austin uses Med+Proctor; other schools have their own systems. At UT Dallas, an enrollment hold lifts by 8:00 a.m. the day after a T-SPOT test is administered.¹⁰¹⁵
Correctional facility employees and volunteers submit the completed certificate to the facility’s HR or health services office, which keeps it on file to comply with Chapter 89 and 25 TAC § 97.173.
Child-care workers put the health card or provider’s statement in their personnel file at the center.⁶
Healthcare workers follow their employer’s occupational health procedures. Most hospitals and clinics have an employee health office that collects and stores results.

Keep a personal copy of everything you submit. Holds can reappear if a portal loses your records, and if you change employers or transfer schools, having your own copies saves weeks of chasing duplicate results.

What Your Documentation Has to Show

For correctional employees and volunteers, 25 TAC § 97.173 requires results on a certificate or similar document, with the Tuberculosis Record in § 97.179 as the recommended format. Anyone with a history of a positive skin test must supply documentation of that test plus any follow-up, signed by a physician or registered nurse.⁵ When providers report to DSHS for surveillance purposes, results should include all documentation and skin test results should be reported in millimeters.¹⁶

Universities set their own documentation standards. UT Austin requires the lab report to contain the student’s name and an interpretation of the result, submitted to the student health center before you try to register.⁹ UT Dallas also requires off-campus results to go to the Student Health Center.¹⁰

Reporting and Privacy After a Positive Result

All 50 states require active TB disease to be reported to public health authorities. Texas goes further and also requires reporting of latent TB infection.¹⁷ The list of mandatory reporters under Texas Health and Safety Code § 81.042 is long and includes physicians, nurses, laboratory directors, school authorities, child-care and higher-education health officials, and correctional institution administrators.¹⁸ If you are diagnosed with active TB, treatment is not optional; Texas health authorities can impose control measures up to and including isolation on someone who refuses treatment and remains infectious.²

Your test results are medical records protected by HIPAA. A healthcare provider generally needs your written authorization before sharing results with an employer, and you will typically sign that authorization alongside your screening paperwork. Narrow exceptions apply for workplace medical surveillance required by law, situations involving a serious and imminent health threat, and workers’ compensation. If you are asked to waive privacy protections beyond what relates directly to the TB screening, you can refuse.

1
Texas DSHS. TB Forms Resources
2
State of Texas. Texas Health and Safety Code 81.082
3
Texas Public Law. Texas Health and Safety Code Chapter 89 – Screening and Treatment for Tuberculosis in Jails and Other Correctional Facilities
4
Office of the Attorney General State of Texas. Letter Opinion No. 98-047
5
Legal Information Institute. 25 Texas Administrative Code 97.173 – Screening
6
Texas Health and Human Services. Minimum Standards for Child-Care Centers
7
Legal Information Institute. 26 Texas Administrative Code 746.627 – Must Children in My Care Have a Tuberculosis (TB) Examination?
8
Centers for Disease Control and Prevention. Baseline Tuberculosis Screening and Testing for Health Care Personnel
9
University of Texas at Austin. Immunization and Medical Clearance Requirements for International Students
10
University of Texas at Dallas. Tuberculosis Screening – Student Health Center
11
Texas DSHS. Congregate Settings Tuberculosis Risk Assessment
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Texas DSHS. Tuberculosis Symptom Screening Form
13
Centers for Disease Control and Prevention. TB Risk and People Born in or Who Travel to Places Where TB Is Common
14
Texas Department of State Health Services. About Tuberculosis – Section: Tuberculosis Screening
15
University of Texas at Tyler. New International Student Tuberculosis (TB) Screen Hold Clearance Process
16
Texas Department of State Health Services. How to Report Tuberculosis
17
Centers for Disease Control and Prevention. Latent Tuberculosis Infection Laws
18
State of Texas. Texas Health and Safety Code 81.042 – Persons Required to Report