Frequently Asked Questions (FAQs) About the Pre-Employment Health Review Process
The following information provides detailed answers to some of the most common questions about completing and submitting your Health Review Form.
Where do I send my completed Health Review Form, and what formats are accepted?
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.
Do I need to complete the health review requirements prior to my start date?
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.
What happens if I am missing immunizations, proof of immunity or TB skin tests, or do not submit a Health Review Form prior to my start date?
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 proof of two COVID 19 vaccinations or has not submitted a signed Health Review Form.
How will I know if I am missing requirements on my 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.
Where can I obtain documentation of my previous immunizations, proof of immunity and TB skin test results?
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.
Where can I have immunizations, serology testing for proof of immunity or a TB skin test done before my start date?
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.
Please note: LHSC does not routinely complete pre-employment immunizations and serology testing.
I was a previous staff member at LHSC. Do I need to complete another Health Review Form?
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.
Has the requirement for two COVID-19 vaccinations changed now that ‘vaccine passport’ requirements are lifted for public places?
No. Similar to other vaccinations for communicable disease, requirements for hospital workers are different than for the general public. LHSC will continue to require two COVID 19 vaccinations as a condition of employment for the foreseeable future.
What is a TB skin test and why do I need one?
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: (1) HIV infection Contact with infectious TB in the past two years Fibronodular disease on chest X-ray Organ transplant TNF alpha inhibitors; (2) Treatment with immunosuppressive drugs (equivalent to 15 mg/day of Prednisone for one month or more)
What’s involved in a two-step TB skin test?
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.
Do I need an annual (one-step) TB skin test if I have already had a two-step?
Maybe. If the two-step has been completed more than one year ago, then an annual (one-step) is also required.
I had a chest X-ray, and it was normal. Do I still need a TB skin test?
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 OHA does not accept chest X-rays as an alternative to a TB skin test.
I had bacillus Calmette–Guérin (BCG) vaccination as a child. Should I still get a TB skin test done?
Yes. BCG vaccination is not a contraindication to the TB skin test. BCG vaccination given before the age of two is an unlikely explanation for a positive TB skin test in adulthood, since immunity from BCG vaccination wains after about 10 years. Therefore, a TB skin test is still needed to screen for latent or active Tuberculosis infection.
My TB skin test is positive, and I am told I need to have a chest X-ray. I had a chest X-ray done for immigration purposes a few years ago. Do I need another one?
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.
I had a positive TB skin test in the past. Do I need another one?
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.
My TB skin test is positive. Is there anything else I need to do?
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.
I had chicken pox as a child. Do I still need to have two vaccinations for varicella?
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.
My serology tests show that I am immune to measles and mumps but not rubella. How do I receive vaccination for rubella?
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.
I am not immune to Hepatitis B. Do I need to complete Hepatitis B vaccination?
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.
I have a latex allergy. What steps do I need to take to make sure I am safe at work?
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.
I have a disability and need workplace accommodation. What do I need to do?
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.
Victoria Hospital: 519-685-8500 ext. 52286
University Hospital: 519-685-8500 ext. 33201