Try for free

Pennsylvania H511.340 School Personnel Health Record

Pennsylvania's Public School Code (Section 1418) requires a pre-employment medical examination for school staff, and the Department of Health's School Personnel Health Record is the form used after a job offer. The examiner records tuberculosis testing, medical conditions and a physical examination, and notes any restrictions, medication effects or accommodations the employee needs to do the job.

Who completes it

The new employee completes the information section and signs the attestation and release. The physician completes the immunization, TB, medical conditions and physical examination sections and signs as examiner.

Submitting and payment

How to submit it
The completed record goes to the employing school entity; the employee's signed authorization allows the examiner to disclose the health information to that employer.
Who pays
The form sets no fee and does not say whether the school entity or the employee pays for the examination.

Good to know

  • TB testing is required under Department of Health regulations: either a skin test with antigen, lot, site and millimeter reading, or an IGRA such as QFT or T-SPOT with result.
  • For a significant reaction, a chest X-ray report is attached and the primary care provider must state the applicant is currently free from tuberculosis disease.
  • The immunization history (Td/Tdap, hepatitis B, MMR with serology, varicella, influenza) is labeled recommended, not mandated by law.
  • The current version is H511.340 (Rev. 5/2019); the Department of Health also posts a Word version, and the law does not allow modification of this requirement.

Get the official form

Download the current version from the source each time; forms change without notice.

School Personnel Health Record

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

See how Vero Documents works

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.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

When is the Pennsylvania school personnel physical done?

The form is for use after an offer of employment has been made. The Department of Health says school staff must have a pre-employment medical examination under Section 1418 of the Public School Code, and the law does not allow modification of this section.

Does H511.340 accept an IGRA instead of a TB skin test?

Yes. The TB section records either a tuberculin skin test or IGRA results, such as QuantiFERON or T-SPOT, marked positive, negative or indeterminate. Known or new positive reactors need a chest X-ray report and a statement that they are free of TB disease.

Are vaccines required for Pennsylvania school employees on H511.340?

The immunization history section is labeled 'Recommended, but not mandated by law.' It has spaces for Td or Tdap, hepatitis B, MMR, varicella and influenza doses, along with serology results where immunity was confirmed by titer.