A common early question from employers—especially healthcare, education, and congregate-care settings—is whether they should be testing all employees for tuberculosis (TB) on a routine cycle, such as every two years.
This question recently came from a new occupational medicine program embedded in an urgent care setting, and it’s a scenario many practices encounter as they begin offering employer services. The request sounds straightforward. In reality, it’s an opportunity to educate the employer, design a compliant service, and position your clinic as a trusted advisor—not just a testing vendor.
Below is a practical way to approach this conversation and set up TB testing services correctly from day one.
The Employer Question: Is Routine TB Testing Required?
The short answer in most cases: No—routine, periodic TB testing of all employees is generally not required.
Current guidance from Centers for Disease Control and Prevention shifted several years ago away from blanket serial testing. Instead, TB surveillance is now risk-based, focusing on:
- Baseline screening at hire (risk assessment + symptom review)
- Targeted testing only if:
- There is a known exposure
- The employee works in a setting with ongoing TB transmission
- The individual has specific risk factors
For most workplaces—even many healthcare environments—testing everyone every 1–2 years adds cost without benefit and may create unnecessary follow-up work from false positives.
What Employers Are Expected to Do
Rather than routine testing, employers are typically expected to have a TB surveillance program that includes:
- Baseline TB screening at hire
- TB risk assessment questionnaire
- Symptom screen
- TB test (TST or IGRA) only if indicated
- Post-exposure testing
- After a confirmed or suspected workplace exposure
- Ongoing symptom surveillance
- Especially for healthcare or high-risk environments
- Clear documentation
- Demonstrating compliance with CDC guidance and applicable state rules
This distinction—surveillance vs. routine testing—is critical for employers to understand, and it’s where clinics add value.
How an Urgent Care Can Set This Up Properly
For an urgent care just entering occupational medicine, TB testing should be framed as a program, not a single test.
Step 1: Start With Employer Education
Your first deliverable is not a test—it’s clarity.
Explain:
- Why routine biennial testing is usually unnecessary
- When testing is appropriate
- How risk-based surveillance protects employees and reduces cost
This conversation builds trust and positions your clinic as a long-term partner.
Step 2: Decide Which Tests You Will Offer
Most clinics choose to support:
- TB Skin Test (TST / PPD)
- Lower cost
- Requires two visits
- More operational coordination
- TB Blood Test (IGRA)
- Single visit
- Higher cost
- Often preferred for BCG-vaccinated individuals
Your role is to help employers choose the right test for the right population, not default to one approach.
Step 3: Build a Simple, Repeatable Workflow
A compliant TB testing workflow includes:
- Intake risk assessment
- Clear criteria for when testing is ordered
- Consistent documentation language
- Employer-friendly summary reports
This is where many new occ health programs struggle—and where having templates matters.
Common Pitfalls to Avoid
- ❌ Agreeing to routine testing “because that’s how they’ve always done it”
- ❌ Testing without documented risk assessment
- ❌ Failing to define who pays for follow-up evaluations
- ❌ Providing results without employer-ready explanations
Avoiding these issues early prevents downstream friction and liability.
Free Resources Available to Everyone
To support clinics navigating these conversations, we’ve made the following public resources available:
- Employer explainer:
“Do We Need to Test Employees for TB on a Periodic Basis?”
A plain-language overview you can share directly with employer clients. - Clinic discussion guide:
Talking points to help staff confidently explain TB surveillance vs. routine testing.
These tools are designed to stand on their own and help you handle TB testing requests professionally—even if you’re just getting started.
Additional Free Resources for NAOHP Members
For members, grab your TB Testing Decision & Employer Communication Guide
Then go deeper with implementation-ready tools, including:
- ✔️ TB Testing Practice brief – policy & procedures
- ✔️ TB testing decision flowchart (risk-based)
- ✔️ Sample TB risk assessment questionnaire
- ✔️ Employer policy language you can co-brand
- ✔️ Documentation and reporting templates
- ✔️ Operational tips for urgent care–based occ health programs
These member discounted resources are built specifically for clinics adding or expanding occupational medicine services—so you’re not reinventing the wheel.
Bottom Line
When an employer asks for TB testing every two years, they’re not asking the wrong question—they’re asking an incomplete one.
Your opportunity as an occupational health provider is to:
- Educate first
- Test appropriately
- Document defensibly
- Build long-term employer relationships
Handled correctly, TB testing becomes a gateway service that introduces employers to the broader value of occupational medicine—not just another checkbox.
If you’d like help turning requests like this into well-designed programs, the free and member resources above are a solid place to start.
