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In the realm of public health and occupational safety, precise measures are put in place to prevent the spread of infectious diseases, especially in environments with high susceptibility such as schools and daycare centers. The South Carolina Department of Health and Environmental Control (DHEC) has instituted a robust framework to mitigate the risk of tuberculosis (TB) through the implementation of the DHEC 1420 form, a pivotal document in this endeavor. This form is designed to document the TB evaluation of school employees or any individual requiring such documentation, ensuring they do not pose a risk to those in their care. It requires a thorough certification process, including tuberculin skin tests or chest X-rays as deemed necessary, followed by a detailed recording of the results and any subsequent treatment actions taken or needed. Moreover, the DHEC 1420 form serves as a testament to compliance with South Carolina's stringent health regulations, specifically outlined in sections 44-29-150, 44-29-160, and 44-29-170 of the state code, mandating that no individual be employed within schools or daycare settings without a clear TB evaluation. Additionally, it outlines clear guidelines for follow-up actions should an evaluation indicate TB infection but not disease, emphasizing the individual's lifelong risk and the necessity for preventive measures. This form, therefore, not only represents a critical step in safeguarding public health within vulnerable populations but also underscores the legal and ethical responsibilities of employers towards disease prevention.

Document Example

School Employee Certificate of Evaluation for Tuberculosis

____________________________________________

________________________________________________________________

Name:

Last

First

M.I.

Residence Address

 

 

City

County

_____________________________________________________________________________________________

___________________________

Worksite,

 

e.g. public or private school, kindergarten, nursery, or daycare facility for infants and children

 

 

Date employed

 

 

 

 

 

 

 

 

 

 

 

 

 

RESULTS

 

TUBERCULIN SKIN TEST ____________

 

 

CHEST X-RAY

 

REMARKS

 

 

 

 

 

Date Given

 

 

Date _______________

 

 

 

 

 

5 TU Mantoux Method

 

 

 

 

 

 

 

____________ mm _______________

 

 

Interpretation:

 

 

 

 

 

 

 

 

Date Interpreted

 

 

 

 

 

 

TEST

IGRA ____________

T Spot QFT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date Collected

 

 

 

 

 

 

 

 

 

 

 

 

Results ________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

________ No tuberculosis infection per 5 TU PPD o r I G R A

r es u l t s 1

 

 

 

 

 

 

________ Tuberculosis infection, no evidence

of disease

a nd completed ___________________.

 

 

DISPOSITION

 

 

_________ Preventive treatment s t a r t e d

 

 

 

________ Current tuberculosis disease

 

 

 

 

 

 

 

 

 

 

 

 

 

_______ Preventive treatment started ___________________but not completed

2

 

 

 

 

 

 

 

________ Preventive treatment not prescribed/refused 2

 

 

 

 

 

 

 

 

History of tuberculosis disease. Treatment started _____________ and completed _______________.

 

 

 

 

 

_______ Non-contagious as of _________________ and medically cleared to start/resume school employment on ______________.

 

 

 

1No further routine screening required unless additional screenings required by employer.

2Remains at lifelong risk of developing tuberculosis.

 

CERTIFI CATION-

_______ This is to certify that I have examined the person named herein for tuberculosis and report my findings as indicated above

 

 

 

pursuant to the Code of Laws of South Carolina, 1976.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

____________________________________________________________________________

_________________________

 

 

Physician’s Signature

 

 

 

 

 

 

 

 

Date

 

DHEC 1420 (07/2017) DISPOSITION: This form shall be retained in the files of the current employer or individual following evaluation and certification.

SCHOOL EMPLOYEE CERTIFICATE OF EVALUATION FOR TUBERCULOSIS: This form may be used for school employees who need

documentation of tuberculosis evaluation. It should be maintained in the current employer’s file for school employees.

CODE OF LAWS OF SOUTH CAROLINA, 1975. SECTION 44-29-150. No person will be initially hired to work in any public or private school, kindergarten, nursery, or day care center for infants and children until appropriately evaluated for tuberculosis according to guidelines approved by the Board of Health and Environmental Control. Re-evaluation will not be required for employment in consecutive years unless otherwise indicated by such guidelines.

SECTION 44-29-160. Any person applying for a position in any of the public or private schools, kindergartens, nurseries, or day care centers for infants and children of the State shall, as a prerequisite to employment, secure a health certificate from a licensed physician certifying that such person does not have tuberculosis in an active stage.

SECTION 44-29-170. The physician shall make the aforesaid certificate on a form supplied by the Department of Health and Environmental Control, whose duty it shall be to provide such forms upon request of the applicant.

SUMMARY OF GUIDELINES OF THE DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL. (Regulation 61-22) As a prerequisite to employment, and as a condition for continued employment, all employees shall be evaluated for tuberculosis by a licensed health care provider and shall provide written certification from a licensed physician that the person does not have TB disease. Tuberculosis evaluations must be completed no more than one year prior to employment. Tuberculosis evaluations shall be conducted utilizing Approved TB Screening Tests. Certification of tuberculosis evaluation, including disposition and preventive treatment, shall be documented on DHEC 1420 and retained in the files of the school, kindergarten, nursery or day care center for infants and children where the person works. These forms shall be subject to review by DHEC. If the evaluation reveals TB disease, then the individual shall be excluded from working in any school, kindergarten, nursery or day care center for infants and children until a licensed physician certifies that the individual no longer has TB in an active stage. Any employee with a positive Approved TB Screening Test or with a history of latent TB infection or TB disease shall be further evaluated by a licensed health care provider with chest x-ray or additional testing. Any employee with a positive Approved TB Screening Test or with a history of latent TB infection or TB disease shall be further evaluated by a licensed health care provider. If the evaluation reveals no TB disease, then no exclusion and no further routine screening shall be required. An employee who would otherwise be exempt from routine annual screening for tuberculosis may be required to undergo non routine screening if there is epidemiologic or clinical evidence that such employee may have been exposed to TB bacteria or become infected with TB or may have moved from having latent TB infection to TB disease as evidenced by the observation of signs and symptoms suggestive of tuberculosis.

DHEC 1420 (07/2017)

Form Properties

Fact Detail
Form Title DHEC 1420
Date of Issue August 1998
Purpose Certificate of Evaluation for Tuberculosis
Applicable For School Employees/Individuals
Governing Law Code of Laws of South Carolina, 1976, as amended April 24, 1979
Relevant Sections Sections 44-29-150, 44-29-160, 44-29-170
Testing Requirements Tuberculin Skin Test (Mantoux Test with 5 TU of PPD)
Additional Test if Necessary Chest X-Ray for reactions of 10mm or more
Form Availability Provided by the Department of Health and Environmental Control upon request
Documentation Location Retained in the files of the current employer or individual
Criteria for Reevaluation Not required for consecutive years unless indicated by guidelines

Guide to Writing Sc Dhec 1420

When it comes to the SC DHEC 1420 form, it serves as a critical document to ensure the safety and health within educational and childcare settings in South Carolina. This form is essentially used for documenting the evaluation of tuberculosis (TB) in individuals employed or seeking employment in schools, kindergartens, nurseries, or day care centers, in accordance with South Carolina law. Filling this form correctly is not just a legal requirement; it's a step towards maintaining a healthy environment for children and employees alike. Here's a straightforward guide on how to fill out the form accurately.

  1. Start with personal information: In the "Name" section, write down your last name, first name, and middle initial. Ensure the spelling matches your legal documents.
  2. Address details: Enter your residence address, including the city and county, in the designated spaces. This helps in establishing your locality within South Carolina.
  3. Employment information: Specify whether you are employed at a public or private school, kindergarten, nursery, or day day care center. Fill in the date you were employed to provide a timeframe of your current employment status.
  4. Tuberculin Skin Test (TST) details: Under "TEST RESULTS", input the date the tuberculin skin test was given and the date it was interpreted. Record the interpretation results in millimeters (mm).
  5. X-Ray Information: If a chest x-ray was conducted, provide the date it was taken. This is usually required if the reaction to the TST measures 10mm or more.
  6. Disposition Certification: This section is crucial and should be filled based on the outcome of the tests. Check the appropriate box that corresponds to your situation:
    • No tuberculosis infection found,
    • Tuberculosis infection without disease (and indicate if prevention treatment was started and/or completed),
    • History of tuberculosis disease with treatment details,
    • Current tuberculosis disease status and whether you are cleared to resume work.
  7. Physician’s Certification: This part is to be completed by the examining physician. Make sure the doctor signs and dates the form to certify the accuracy of the information and the results of the TB evaluation.
  8. Disposition: Remember, after the form is filled, it should be retained in the files of the current employer or for personal records if you are the individual being evaluated. This is in line with South Carolina's health regulations.

By following these detailed steps, you can ensure that the SC DHEC 1420 form is filled out comprehensively and correctly. Keeping this documentation up to date plays an essential role in safeguarding the well-being of school and daycare populations from the risks associated with tuberculosis.

Understanding Sc Dhec 1420

What is the purpose of the SC DHEC 1420 form?

The SC DHEC 1420 form is used for documenting a tuberculosis evaluation for school employees or other individuals who require proof of such an examination. This evaluation is a requirement for anyone seeking to work in public or private schools, kindergartens, nurseries, or day care centers for infants and children in South Carolina. The primary purpose is to ensure that individuals do not have tuberculosis in an active state before they are employed.

Who needs to complete the SC DHEC 1420 form?

Any person applying for a position in South Carolina public or private schools, kindergartens, nurseries, or day care centers must complete the SC DHEC 1420 form as part of their employment prerequisites. This requirement is in place to ensure the safety and health of the school’s students and staff by preventing the spread of tuberculosis.

What are the key sections of the SC DHEC 1420 form?

The SC DHEC 1420 form includes several key sections: personal information of the employee, test results, disposition, and certification by a physician. The form documents the results of a tuberculosis skin test or a chest x-ray, along with any necessary treatments or remarks by the examining physician. Finally, the form is certified by the physician, confirming the individual’s tuberculosis status according to the South Carolina Code of Laws.

How is the Tuberculin Skin Test performed?

The Tuberculin Skin Test on the SC DHEC 1420 form is performed using the Mantoux method, which involves an intradermal injection of 5 tuberculin units of purified protein derivative (PPD). The skin’s reaction to the injection is measured in millimeters of induration (swelling), which helps determine if further testing, such as a chest x-ray, is necessary.

What happens if the test indicates possible tuberculosis infection?

If the Tuberculin Skin Test indicates a possible tuberculosis infection — typically a reaction of 10mm or more — the individual is required to undergo a chest x-ray to look for signs of active tuberculosis disease. If the chest x-ray shows current disease, the employee cannot work until they receive written certification from DHEBREAKTHAT there are not contagious. If the chest x-ray is normal, the individual will be evaluated for preventive therapy for their tuberculosis infection.Is reevaluation for tuberculosis required for continued employment?Reevaluation for tuberculosis is not required for continued employment in consecutive years unless otherwise indicated by the guidelines set forth by the South Carolina Department of Health and Environmental hatECONTROL. This means that as ong as the initial evaluation does not indicate active tuberculosis, and guidelines do not change, an annual re-test is not mandatory.Where should the completed SC DHEC 1420 form be kept?

The completed SC DHEC 1420 form should be maintained in the files of the current employer for school employees. For other individuals, it should be kept by the employer or the individual who required the evaluation. This ensures that the documentation is available for review if necessary by the Department of Health and Environmental10trol.How can I obtain the SC DHEC 1420 form?

The SC DHEC 1420 form can be obtained from the South CarolinaAYDepartmentSTATofLLUHealthSTAEnvironmentalONTROL (DTRACTHEC), either by request through their website or by contacting them directly. They provide these forms to ensure that individuals and employers have easy access to the necessary documentation for tuberculosis evaluation and compliance with state health regulations.

Common mistakes

    Here are ten common mistakes people make when filling out the SC DHEC 1420 form:

  1. Not providing complete name information, including last name, first name, and middle initial, which is crucial for accurate record-keeping.
  2. Forgetting to fill out the residence address completely, including city and county, which makes it difficult to locate records or correspond if needed.
  3. Incorrectly reporting the type of facility where they are employed, whether it is a public or private school, kindergarten, nursery, or day care center, which is important for compliance purposes.
  4. Leaving the date employed blank or incorrectly filled, which is essential for tracking the individual's employment status concerning the tuberculosis testing.
  5. Failing to record the test results properly, specifically the dates given and interpreted for the Tuberculin Skin Test or the Chest X-Ray, leading to incomplete evaluation documentation.
  6. Misinterpreting or inaccurately reporting the interpretation of the test results, such as the measurement in millimeters for the Mantoux method, which could lead to improper treatment or action.
  7. Omitting the disposition certification information, which indicates the individual's current tuberculosis infection status and any treatment commencement or completion, is essential for determining their eligibility for employment.
  8. Overlooking to specify if preventive treatment for tuberculosis was started but not completed, not prescribed, or refused, which is crucial for assessing the health risk to others.
  9. Not indicating a history of tuberculosis disease and treatment completion status, which is important for following up on the individual's health and ensuring safety in the workplace.
  10. Forgetting to sign and date the form by the examining physician, which certifies the accuracy of the reported findings and compliance with South Carolina's regulations.

    In addition to these specific errors, individuals also commonly encounter these general issues when completing the form:

  • Misplacing the form after its completion, since it must be retained in the files of the current employer or individual following evaluation and certification.
  • Failing to understand the importance of the form, which is used not only for school employees but also for individuals who need documentation of tuberculosis evaluation in various employment settings.
  • Not being aware of the legal requirements, as laid out by the Code of Laws of South Carolina, concerning tuberculosis evaluation for employment in schools, day cares, and similar establishments.
  • Lack of familiarity with the guidelines from the Department of Health and Environmental Control (DHEC), particularly regarding the necessity and frequency of tuberculosis testing and evaluation.

Documents used along the form

When addressing the requirements and procedures for tuberculosis screening and reporting as outlined in the SC DHEB 1420 form, individuals and employers often need to engage with a variety of supplemental documents to ensure compliance and thorough record-keeping. These documents play a vital role in maintaining health standards and legal compliance within educational and childcare settings. Here, we describe six commonly associated documents that support and extend the use of the SC DHEC 1420 form.

  1. Employee Health Record: This comprehensive document keeps track of an employee's overall health status, including but not limited to tuberculosis testing results. It serves as a centralized record for all health-related screenings and vaccinations required for employment, ensuring that all health prerequisites are met and maintained over time.
  2. Consent for Release of Medical Information: In situations requiring the exchange of health information between medical providers and employers or educational institutions, this form authorizes the sharing of specific medical results, such as tuberculosis testing, ensuring privacy and compliance with healthcare information regulations.
  3. Physician’s Certification of Health: Beyond tuberculosis tests, this certificate is provided by a healthcare professional to certify that an individual is free from communicable diseases and physically fit to work or attend school, based on comprehensive health screening.
  4. Immunization Records: This document is critical in educational and childcare settings, recording vaccinations against diseases other than tuberculosis. It ensures that individuals are appropriately protected and comply with public health requirements for communal settings.
  5. Emergency Contact and Medical Information Form: Although not directly related to tuberculosis, this form provides essential information for the safety and welfare of employees and students, including allergies, pre-existing conditions, and contacts in case of a health emergency.
  6. Incident Report Forms: In the event of an exposure incident or the identification of a tuberculosis case within a school or childcare setting, this form would document the details of the incident, the individuals involved, and the response taken to mitigate further risk of transmission.

Together with the SC DHEC 1420 form, these documents create a framework for managing health risks in sensitive environments, such as schools and childcare facilities. They ensure not only the well-being of employees and individuals but also uphold public health standards and safeguard the communities they serve.

Similar forms

The I-693 Form, also known as the Report of Medical Examination and Vaccination Record, is similar to the SC DHEC 1420 form in that it requires health screening and certification by a licensed physician. This form is used by individuals applying for U.S. permanent residency (green card) to prove they do not have any communicable diseases that could pose a public health risk, including tuberculosis. Just like the SC DHEC 1420 form, the I-693 requires a tuberculosis test (either a skin test or IGRA), and if the initial test indicates potential tuberculosis infection, further evaluation such as a chest X-ray might be required. Both forms are designed to certify the health status of an individual with respect to specific health standards and guidelines.

The OSHA Respirator Medical Evaluation Questionnaire is another document bearing similarities to the SC DHEC 1420 form. This questionnaire is part of the respiratory protection standard requirements for employees who wear respirators in the workplace. It assesses the employee's health and physical condition to determine their ability to safely wear a respirator, somewhat akin to how the SC DHEC 1420 form evaluates an individual's tuberculosis status to ensure they can safely work in a school setting. Both documents are preventive measures aimed at protecting public health and safety by assessing health risks related to respiratory conditions.

The Employee Health Certification form, often used in the food service and healthcare industries, shares similarities with the SC DHEC 1420 form as well. This certification requires employees to be evaluated for various communicable diseases and conditions that could pose a risk to public health. Like the SC DHEC 1420 form, it may include tuberculosis screening, among other health evaluations, to certify an employee's health status before they can commence or continue working, particularly in environments where they are in close contact with other individuals.

Lastly, the School Entry Health Exam Certification, required for children enrolling in public schools, parallels the SC DHEC 1420 form in its objectives and procedures. This certification typically includes a comprehensive health examination, encompassing immunization records and tuberculosis testing, akin to the TB evaluation documented by the SC DHEC 1420 form for school employees. Both forms serve the purpose of ensuring a safe and healthy environment within educational settings by screening for conditions that could potentially harm the individual or public health.

Dos and Don'ts

When completing the SC DHEC 1420 form, it's important to adhere to certain guidelines to ensure accuracy and compliance. Here are key dos and don'ts:

  • Do ensure that all information is legible and accurate, including full name, residence address, and employment details.
  • Do not leave any sections incomplete, as each part of the form is crucial for evaluating tuberculosis status.
  • Do provide precise test results, including dates and outcomes of the tuberculin skin test or chest X-ray, as applicable.
  • Do not forget to indicate whether prevention treatment was started and/or completed, including dates, as this information is critical for health records.
  • Do accurately report the disposition, ensuring to note if the individual does not have tuberculosis or if they remain at risk.
  • Do not disregard physician certification, which validates the examination and findings. It must be signed and dated.
  • Do keep the completed form in the appropriate files, either with the current employer or the individual, as specified in the form's guidance.
  • Do not overlook the guidelines and laws detailed in the form, including the necessity of testing before employment in certain facilities and the requirement for a physician's certification of non-contagious status.

Adhering to these guidelines ensures compliance with South Carolina's health standards and contributes to the overall well-being and safety of employees, students, and children in care settings.

Misconceptions

When discussing the SC DHEC 1420 form, several misconceptions often arise. Clarifying these misunderstandings is vital for both school officials and potential employees in South Carolina.

  • Only for Public School Employees: One common misconception is that the SC DHEC 1420 form is exclusively for individuals seeking or currently employed in public schools. In reality, this form is also required for those working in private schools, kindergartens, nurseries, or day care centers. This broad scope ensures that all individuals working with children are evaluated for tuberculosis.
  • No Reevaluation Needed: Some believe that once they have been cleared of tuberculosis through the initial assessment, they will never need to be reevaluated. However, the guidelines stipulate that reevaluation may be necessary if there is epidemiological evidence of exposure to tuberculosis. This ensures ongoing safety and health within educational settings.
  • The Form Replaces Regular Health Check-ups: Another misconception is that the SC DHEC 1420 form substitutes for regular health check-ups with a physician. While it specifically addresses tuberculosis evaluation, it doesn't cover other health aspects that may be reviewed during a routine physical examination. Individuals should continue regular health assessments independent of this tuberculosis evaluation.
  • Positive Skin Test Equals Job Disqualification: Finally, there's a misunderstanding that a positive skin test automatically disqualifies an individual from employment. Not true. If the skin reaction measures 10mm or more, and the chest X-ray is normal, the individual is evaluated for preventive therapy. They can still be employed, assuming they have no active tuberculosis disease and depending on the completion of preventive therapy if prescribed.

Understanding these key points about the SC DHEC 1420 form clarifies its role in the employment process for South Carolina's educational institutions. It's about ensuring a safe environment for children and staff by preventing the spread of tuberculosis, not about imposing unnecessary barriers to employment.

Key takeaways

When filling out the SC DHEC 1420 form for tuberculosis (TB) evaluation, it is essential to understand its key components and guidelines to ensure accurate completion and compliance with South Carolina regulations. Below are vital takeaways to consider:

  • The SC DHEC 1420 form serves dual purposes: it is used both for screening school employees and individuals for tuberculosis.
  • Under South Carolina law, anyone seeking to be employed at a public or private school, kindergarten, nursery, or daycare must be evaluated for TB as per the guidelines set by the South Carolina Department of Health and Environmental Control (DHEC).
  • The form requires basic personal information and detailed results of TB tests, specifically the tuberculin skin test (TST) results, chest X-ray findings, and any remarks related to TB prevention treatment.
  • The Mantoux method, involving an intradermal injection of 5 tuberculin units of purified protein derivative (PPD), is the recommended test for TB screening indicated on the form.
  • If the skin test reaction is 10mm or more, or if the test results raise concerns, a chest X-ray and further evaluation are necessary. The results must be documented on the form.
  • In cases where TB infection is detected but shows no evidence of active disease, the form must indicate whether prevention treatment was started and/or completed. If preventive therapy is prescribed but not followed, this must also be noted on the form.
  • For individuals with a history of tuberculosis or current TB disease, the form should detail the treatment received and certify whether the individual is non-contagious and medically cleared to work.
  • Once completed, the form must be retained in the files of the current employer or by the individual for documentation purposes, as it provides a certified record of TB evaluation as per South Carolina's legal requirements.

Understanding and adhering to these guidelines when filling out and submitting the SC DHEC 1420 form ensures compliance with South Carolina laws and promotes a health-conscious environment in schools and daycare centers.

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