Sample Pre-Program Needs Assessment

This form should be used prior to providing an educational program on TB. It may be given to school nurses and then summarized to assist in choosing the topics for presentation. To download a copy of this form, please click here.


1. Please check which TB-related topics you would like addressed in an educational session.

_____transmission

_____Mantoux Tuberculin Skin testing

_____treatment of TB infection

_____treatment of TB disease

_____directly observed therapy (DOT)

_____other(s) _______________________________________ (please specify)

2. Do you feel comfortable with the administration and interpretation of Mantoux Tuberculin skin tests?

If no, on what aspect of Mantoux Tuberculin skin testing would you require a review?

Administration Interpretation Both administration & interpretation (Circle one)

3. Do you completely understand the follow-up process for positive skin test reactors?

If no, what questions or concerns do you have about the procedure?

4. What other TB-related questions do you have?

Next page