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TB Clearance Letter Template
A TB clearance letter tells an employer or school how you screened your patient for tuberculosis, and that there is no evidence of active TB. Copy the template, see a negative blood test and a positive skin test with a normal chest X-ray, and check the official screening guidance for health care workers and schools.
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- Word and text downloads
- Two filled examples
Blank TB clearance letter template
FreeTB CLEARANCE LETTER [Practice or occupational health clinic name] [Address] [Phone and email] Date: [Date you write the letter] To: [Employer, school, program, or To whom it may concern] Re: [Patient's full name] Date of birth: [Date] Role or program: [Job title, placement, or volunteer role, if the requester gave one] [Patient name] asked me for this letter and agreed to what it shares. TB HISTORY Prior positive TB test or TB disease: [None, or the year, the test, and any treatment, with records if available] BCG vaccine: [Not received, received, or unknown] TB TEST Test: [TB blood test, naming the IGRA, or tuberculin skin test, one-step or two-step] Date: [Date the blood was drawn, or the dates the skin test was placed and read] Result: [Negative, positive, or indeterminate; for a skin test, the induration in mm] CHEST X-RAY [Not needed: negative test and no symptoms; or the date of the X-ray and the result, e.g. no evidence of active TB] Other tests: [Sputum tests and their results, if symptoms or the X-ray called for them, or none] SYMPTOM SCREEN Date: [Date] Result: [No prolonged cough, coughing up blood, fever, night sweats, weight loss, or unusual tiredness; or what was found and how it was assessed] CONCLUSION [No evidence of active TB disease, or TB infection without active disease and not contagious, in the requester's terms] From a TB standpoint, [patient name] can [start work, attend school, or begin the placement]. TREATMENT FOR TB INFECTION [Not applicable; or offered on date, and started, completed, or declined. Include only if the patient agrees] NEXT SCREENING [Not needed unless there is an exposure or new symptoms, or what the employer's policy or local rules require] [Your name, credentials] [License or registration number] [Signature] To verify this letter: [Practice phone or email]
Use it for
- New hires in hospitals and clinics
- Long-term care and home care staff
- Teachers and school volunteers
- Child care staff
- Student clinical placements
Two filled examples. Every part, filled in.
Each one follows the template. Use them to judge how much detail every part needs.
TB clearance letter: new nursing hire, negative blood test
Occupational health clinic, pre-placement screening for a hospital
Patient
26-year-old newly hired registered nurse, starting on a medical unit on Monday, November 2, 2026. The letter goes to the hospital’s occupational health department.
TB history
No prior positive TB test, no TB disease, and no known contact with TB. Received BCG as a child, so a TB blood test was used, which BCG doesn’t affect.
TB test
TB blood test, an interferon-gamma release assay, drawn on Monday, October 12, 2026: negative.
Symptom screen
On Thursday, October 15, 2026: no prolonged cough, coughing up blood, fever, night sweats, weight loss, or unusual tiredness.
Chest X-ray
Not needed: negative test and no symptoms.
Conclusion
No evidence of active TB disease. From a TB standpoint, she can start work on November 2. No repeat testing is planned unless she has an exposure or new symptoms, or hospital policy requires it.
Signed
Occupational health physician, with credentials, license or registration number, signature, and the clinic’s phone for verification. Issued October 15, 2026.
TB clearance letter: positive skin test, normal chest X-ray
Family practice, pre-employment screening for a new teaching job
Patient
41-year-old teacher starting at a new school. He lived for 3 years in a country with a high TB rate. No BCG vaccine, no prior TB test, and no known TB contact.
TB test
Tuberculin skin test placed on Monday, October 5, 2026, and read on Wednesday, October 7, 2026: 14 mm induration, positive.
Chest X-ray
Taken on Friday, October 9, 2026. The radiologist reports a normal chest X-ray, with no evidence of active TB.
Symptom screen
On Tuesday, October 13, 2026: no cough, coughing up blood, fever, night sweats, weight loss, or unusual tiredness.
Conclusion
Latent TB infection, not active TB disease. He is not contagious, and from a TB standpoint he can work with students without restrictions.
Treatment for TB infection
Offered on October 13, 2026. He chose a 3-month course, starting on Monday, October 19, 2026, and can keep working during it. Included at his request.
Signed
Family physician, with credentials, license or registration number, signature, and the practice’s phone for verification. Issued October 13, 2026. If the school has its own TB form, the same facts go on it.
Who needs TB screening, and what it includes. Checked October 2026.
Guidance for health care workers, and rules for schools, child care, and long-term care, decide what a TB clearance letter needs to show. An employer’s or program’s own policy can differ, so check what it asks for.
United States, health care personnel
All health care personnel should have baseline TB screening: an individual risk assessment, a symptom evaluation, and a TB blood test or skin test for those without documented prior TB infection or disease. Personnel with a newly positive test should have a symptom evaluation and a chest X-ray to assess for TB disease.
Canada, health care workers
All health care workers should have baseline TB screening: a risk assessment, a symptom evaluation, and a tuberculin skin test for those without documented prior TB disease or infection, done as a 2-step test unless a prior negative 2-step test is documented. A worker with a positive skin test should be assessed for active TB, with a chest X-ray and a medical evaluation, and treatment of TB infection is encouraged.
United States, health care personnel, after baseline
Without a known exposure or ongoing transmission, personnel without TB infection should not have routine serial testing at any interval, such as annually; facilities might consider it for some groups at higher risk. Personnel with untreated TB infection should be offered, and strongly encouraged to complete, treatment, and those who don’t complete it should have an annual symptom evaluation. A prior positive test with a documented normal chest X-ray needs no repeat X-ray unless there are symptoms or treatment is starting.
Canada, health care workers, after baseline
The Standards recommend against routine periodic TB testing of all health care workers with a negative baseline test; periodic testing may be warranted for workers at higher risk, based on the organization’s risk assessment. The skin test is the preferred test for pre-employment and periodic testing, an IGRA is not recommended for repeated testing, and a worker who was skin-test positive should not be skin-tested again.
California schools and child care
School district, private school, nursery school, and community college employees, contracted pupil transportation staff, child care center teachers, and volunteers with frequent or prolonged contact with pupils need a TB risk assessment by a health care provider, using the state questionnaire, and a TB test and examination if risk factors are found. The provider completes the state’s Certificate of Completion. School employees repeat the risk assessment every 4 years, unless otherwise required.
California schools, after a positive test
A person with a positive TB test can’t start work until the chest X-ray is done and they are found free of infectious TB, and only a physician, physician assistant, or nurse practitioner may sign the certificate. Once a documented positive test is followed by an X-ray showing they are free of infectious TB, repeat risk assessments and X-rays are no longer required.
Ontario long-term care homes
Staff must be screened for TB and other infectious diseases following any standard or protocol issued by the Director under the regulation. Each resident must be screened for TB within 14 days of admission, unless they were screened in the 90 days before admission and the documented results are available to the home.
What goes in each part.
Requester and patient
Who the letter is for, who it is about, and that the patient asked for it.
- Your practice or clinic’s name, address, and phone
- The patient’s full name and date of birth
- The job, school, or placement, if the requester named one
- That the patient asked for the letter and agreed to what it shares
Avoid: Unrelated history. The requester needs the TB screen, not the rest of the chart.
TB history and BCG
A documented positive test or past TB changes what you do: no repeat skin or blood test, but a symptom review, and a chest X-ray if the guidance you follow calls for one.
- Any prior positive test, with the year and a copy if the patient has one
- Past TB disease, or past treatment for TB infection
- BCG vaccine, which can make a skin test positive but doesn’t affect a TB blood test
Avoid: Repeating a skin test on someone with a documented positive one. Record the old result, and review symptoms instead.
The TB test
The test you used, when, and the result, so the reader can check it against their policy.
- Blood test: which IGRA, the date drawn, and positive, negative, or indeterminate
- Skin test: the date placed, the date read, and the induration in mm
- Both steps of a 2-step skin test, if the requester asked for one
- A copy of the lab report or skin test record, if the requester wants proof
Avoid: “Negative” for a skin test with no read date or measurement. The reader can’t check it.
Chest X-ray and symptoms
A positive test can’t tell TB infection from active disease. The chest X-ray and the symptom review do that.
- The X-ray date and the radiology result, after any positive test
- The symptoms you asked about, and the answer
- Sputum or other tests, if the X-ray or symptoms called for them
Avoid: Writing the letter before the X-ray is read. A positive test alone isn’t clearance.
Conclusion and treatment
The answer the reader needs: whether there is any evidence of active TB, in the words their form or policy uses.
- “No evidence of active TB disease,” or “free of infectious TB” if that is the requester’s term
- For a positive test with a normal X-ray and no symptoms: TB infection, not active disease, and not contagious
- Treatment for TB infection: offered, started, completed, or declined, if the patient agrees to share it
- When screening should repeat, if at all
Avoid: “TB negative” for a patient with TB infection. Say what the tests showed, and that there is no active disease.
Signature and verification
Your details, so the reader can trace the letter to you and check it.
- Your name and credentials
- Your license or registration number
- Your signature and the date
- A phone number or email for verification
Avoid: Sharing more than “yes, I wrote it” when someone calls to check. Share nothing else without the patient’s consent.
Common mistakes, and how to avoid them.
Clearing a positive test too early
A positive skin or blood test can’t tell TB infection from active disease. Write the letter once the chest X-ray is read and you have reviewed symptoms.
“TB negative” after a positive test
A patient with TB infection and a normal X-ray isn’t TB negative. Say they have TB infection without active disease, and aren’t contagious, in the requester’s terms.
Retesting a known positive
Don’t repeat a skin or blood test after a documented positive one. Record the old result, review symptoms, and get a chest X-ray if the requester or the guidance you follow calls for one.
A skin test result no one can check
Read a skin test 48 to 72 hours after placing it, and record the date read and the mm of induration. Never write a result the patient read or reported.
Sharing more than the screen
The requester needs the TB results and your conclusion. Leave out unrelated history, and add treatment details only if the patient agrees.
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Frequently asked questions.
What should a TB clearance letter include?
The test, its date and result, and for a skin test the date read and the induration in mm. If the test was positive, add the chest X-ray date and result. Then the symptom screen, your conclusion that there is no evidence of active TB disease, and any treatment for TB infection, if the patient agrees to share it.
Can a patient with a positive TB test be cleared for work?
Yes, once active TB is ruled out. A positive skin or blood test with a normal chest X-ray and no symptoms is TB infection, not active disease, and the patient can’t spread TB to others. Say so in the letter, and record whether treatment was offered.
Does the BCG vaccine affect a TB test?
It can make a skin test positive. TB blood tests, or IGRAs, aren’t affected by BCG, so a blood test is often preferred for people who had the vaccine.
Is a chest X-ray enough for TB clearance?
Usually not on its own. A chest X-ray looks for active disease but doesn’t show TB infection, so it is used after a positive skin or blood test, or for someone with a documented positive test in the past.
Do health care workers need a TB test every year?
Not routinely, under current guidance for health care workers in many places. After a negative baseline test, testing repeats after an exposure, with new symptoms, or in some higher-risk roles. Employers and programs set their own policies, so check what they ask for.
How long is a TB clearance letter valid?
There’s no single rule. The employer, school, or program decides how recent the results must be and when screening repeats, so ask before you test.
Is this TB clearance letter template free?
Yes. Copy it, or download it as a Word or text file. No account needed.
Can Vero write a TB clearance letter from my visit?
Yes. Paste this template into Vero, and it drafts the letter from your visit, with the test results, the chest X-ray, and the symptom screen you discussed. Review and edit it, then export it to PDF or Word, print it, or email it.
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Vero Documents
Fill an employer’s or school’s TB form from the visit and the chart.
Medical forms library
Official forms, including school and child care TB forms, with links and how to file.
Your template. Filled in from the visit.
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