Test/Immunization Record

See at a glance the complete record of resident, employee or volunteer TB tests/immunizations/vaccinations!

Updated to include COVID-19 vaccines, this form provides for recording essential information for each test/vaccine administered, including results/reactions, lot numbers, site, etc. For immunizations that are not ordered annually, indicate year received, if known.

Includes: 

•         TB Screening

•         COVID-19 Vaccines

•         Pneumococcal Vaccines -  PPSV23 and PCV13

•         Influenza Vaccines - Standard Trivalent, High Dose Trivalent, Quadrivalent, Other

•         Herpes Zoster Vaccines

•         Hepatitis B Vaccine

•         Tetanus Toxoid Vaccine

•         Tetanus/Diphtheria (Td) Vaccine

Download a sample today!