Department-approved TB risk assessment used to decide whether testing is needed before issuing a Hawaii TB clearance.
- Completed by
- Health care provider
- Issued by
- Hawaii Department of Health, Tuberculosis Control Branch
- Format
- Language
- English
Hawaii TB Clearance Form (TB Document F)
Hawaii Administrative Rules chapter 11-164.2 require TB clearance for school entry, school and child care staff, food handlers and people living or working in DOH-licensed health care and residential care settings. Form F is the department-approved clearance: the practitioner certifies that, using the DOH TB Clearance Manual process, the person does not have TB disease, and records the basis.
Who completes it
A licensed MD, DO, APRN, NP or PA interprets the risk assessment, symptom screen, TST or IGRA and any chest X-ray, then signs or stamps Form F. RNs and LPNs may read TSTs and complete Forms G and H but cannot issue the clearance.
Submitting and payment
- How to submit it
- Give the signed form to the patient for the school, employer or facility.
Good to know
- Form F has three sections: schools, child care and food handlers; initial screening for health care or residential settings; and annual screening for those settings.
- DOH strongly urges use of Form F; a facility's EMR-based alternative must contain the same wording.
- IGRA is valid only for persons 2 and older, and Indeterminate or Equivocal QuantiFERON results cannot be accepted as negative.
- TB skin test results from another country are not accepted. The fillable version is dated 10/08/2025.
Get the official form
Download the current version from the source each time; forms change without notice.
State of Hawaii TB Clearance Form (TB Document F)
How this list is checked
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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Frequently asked questions
Who can sign a Hawaii TB clearance?
A licensed MD, DO, APRN, NP or PA. The DOH TB Clearance Manual lets an RN or LPN measure and document TSTs and complete the risk assessment (Form G) and symptom screen (Form H), but issuing the clearance requires a licensed provider to interpret those results.
Can a low-risk person get a Hawaii TB clearance without a skin test?
In some categories, yes. For school, child care and food handler clearance, a negative risk assessment and symptom screen can support a clearance without a TST or IGRA. Adults living or working in DOH-licensed health care facilities still need a test for TB infection at initial screening.