Health Review Frequently Asked Questions

Applicants should submit their completed Health Review Form and proof of immunizations and testing to Occupational Health and Safety Services (OHSS) via HealthReviews@lhsc.on.ca in pdf format. Images (pictures) of forms are not accepted.  

Adobe has apps for smartphones that can create pdfs from images that greatly improve the quality of the document. More information is available at: Adobe Mobile Scanner App Alternatively, you can fax your documents to 519-685-8374.

Yes. All new employees must submit their LHSC Health Review Form, proof of required immunizations and immunity, and TB screening at least seven business days prior to their start date. Therefore, it is advised to start the health review process four-to-six weeks before your start date to complete any outstanding requirements.

You will not be cleared to start working at LHSC until all the requirements outlined on the Health Review Form are completed, and proof of these is submitted. Your start date may be delayed providing time to complete your outstanding requirements. In some circumstances a conditional clearance may be provided that would allow you to start working with conditions on your employment. Conditional clearance requires that the employee and the leader both sign an agreement to complete the requirements by the due date determined by OHSS or be placed on an unpaid leave of absence. Conditional clearance is not granted when the employee has not submitted a signed Health Review Form 

An Occupational Health Nurse will review your Health Review Form and contact you if there are any outstanding requirements. Once you have submitted all of the required documentation, you and your leader will receive an email from OHSS indicating you are cleared to begin employment.

Immunization records, proof of immunity and results of TB skin tests are available from your primary care provider (physician or nurse practitioner), local public health agencies, universities and college health services, immigration records, or occupational health services at a previous employer.

Your primary care provider (physician or nurse practitioner) community clinics, public health agencies, student health or occupational health services at your current place of employment/placement are all potential options where immunizations, serology and TB skin tests may be accessed.  

If you do not have a primary care provider and are experiencing challenges completing your requirements, you may be eligible to have immunizations and tests completed in OHSS at LHSC. Contact one of the OHSS offices to inquire about this option as soon as possible.

If MMR and Varicella vaccines are both required, these must be administered as separate vaccine doses, as the combined MMRV vaccine is not valid for individuals over the age of 13 years and will not be accepted.

Yes. A new Health Review Form provides the opportunity to submit up to date immunization documentation and to inform (OHSS) of any changes in your health status. The OHA has updated the pre-employment requirements and therefore OHSS needs to review your immunization and TB status to be sure you meet current OHA communicable disease guidelines.

A TB skin test, also known as a Mantoux Skin Test, involves injecting a small amount of tuberculin substance intradermally (between the first layers of skin) in the forearm. The test is read 48-to-72 hours after injection to determine the result. A positive TB skin test is a response that involves a level of induration (firm swelling) greater than 10mm.* The amount of redness resulting from the test is not measured as part of the result. Every employee at LHSC requires baseline TB testing to be used in the event there is an occupational exposure to TB.

* A reading of 5mm of induration or greater is considered positive if the following criteria are met:

• HIV infection
• Contact with infectious TB in the past 2 years
• Fibronodular disease on chest x-ray
• Organ transplant
• TNF alpha inhibitors
• Treatment with immunosuppressive drugs (equivalent to 15 mg/day of Prednisone for 1 month or more)

Two-step TB skin test is a series of two separate TB skin tests administered at least one week, and no more than one year apart. Both TB skin tests need to be read 48-to-72 hours after being administered by a qualified professional and documented to reflect the level of induration (firm swelling). In total, four visits to a health care provider are required to complete the two-step TB skin test.  

The minimum interval that a two-step TB skin test can be completed is nine days. All staff, regardless of their role at LHSC, are required to have a two-step TB skin test.

Maybe. If the two-step has been completed more than one year ago, then an annual (one-step) is also required.

Yes. In hospitals, TB skin tests are used for surveillance purposes and to identify cases of Latent TB Infection (LTBI), whereas chest X-rays are used to rule out active or previous TB infection. LTBI can be activated by many factors or could stay silent (latent) life-long and therefore would not appear on an X-ray. TB skin tests are the cornerstone of hospital TB surveillance. Without knowing the baseline TB skin test status of each employee, it is not possible to know if, following an exposure, the staff member was exposed at work. The Ontario Hospital Association (OHA) does not accept chest X-rays as an alternative to a TB skin test.

The chest x-ray must be completed after the TB skin test was read. Therefore, if your positive TB skin test was completed after the immigration chest X-ray, then another chest X-ray is required.

No. Once you have had one positive TB skin test, you should avoid having another one in the future. There are two reasons for this: to prevent having a severe blistering reaction; and once positive, always positive, therefore there is no value in completing another one. You are required to submit proof of your previously positive TB skin test.

Yes. All LHSC Staff who have a history of a positive TB skin test must complete Section C: Tuberculosis Questionnaire of the Health Review Form. A nurse practitioner will review the TB Questionnaire and your chest X-ray and determine if any other steps need to be taken to clear you for employment related to TB. Once this step is completed, a nurse practitioner will schedule a health teaching appointment with you to review.

New employees who have a history of chicken pox may be immune to varicella. However, a serology test is required to demonstrate immunity. If not immune, two varicella vaccinations given four weeks apart are required.

Typically, measles, mumps and rubella are given together as MMR. If you are immune to one or two components of MMR, receiving another MMR is safe and often provided since it is difficult to obtain measles, mumps and rubella as individual vaccines.

It is highly recommended, but not required, that all new employees are immune to Hepatitis B in the event that you experience blood and body fluid exposure through a needle stick or sharps injury while at work. New employees who are not immune to Hepatitis B are encouraged to start the Hepatitis B vaccination series prior to beginning their employment, but do not have to complete the series in order to begin working.

The first step is to add this information to your Health Review Form in Section A: Health History. An Occupational Health Nurse will follow up with you to gather more information about your allergy, and to explain the accountabilities of LHSC, your leader and you as the employee in relation to avoiding latex in the workplace.

Section A: Health History of the Health Review Form provides a space for you to indicate that you have a disability or limitations and restrictions that require accommodation in the workplace. An Occupational Health Nurse will review this information and refer you to an Abilities Case Management Specialist, Safety Specialist or Ergonomist to address your needs.

For additional assistance regarding the Health Review Form, please contact Occupational Health and Safety Services, Monday to Friday, 8 a.m. – 4 p.m.