Human Resources
Workplace Health and Safety
To: All AHS Residents: Date: June 1 st , 2014
Re: Communicable Disease Assessment (formerly Baseline Screening Assessment) Residency Program
Welcome:
As outlined in the AHS Communicable Disease Policy, Workplace Health & Safety recommends that you provide the following documentation (no verbals will be accepted; with the exception of Varicella): The Alberta Health Services WHS Communicable Disease
Assessment (CDA) form is to be fully completed. The requirements are as follows:
Tuberculosis Screening
– Tuberculin Skin Test (TST) baseline for all new employees. A TST done within the past 12 months is acceptable if documentation is provided.
– A baseline two-step TST should be performed only if it is anticipated that the employee will undergo repeated screening with TST at regular intervals. This includes:
• Health care worker (HCW) is involved in high-risk activities (regardless of age or BCG history) such as:
 cough-inducing procedures
 autopsy
 morbid anatomy and pathology examination
 bronchoscopy
 designated mycobacteriology laboratory procedures especially handling cultures of M. Tuberculosis
• HCW who work on high-risk units to which patients with active TB are admitted
• HCW at facilities that require TST screening at regular intervals such as high-risk homeless shelters or inner city agencies.
– In the event of a past or present Significant/Positive TST, WHS will require a copy of a recent (within the last 12 months) chest x-ray report.
MMR – Measles, Mumps and Rubella
– Evidence of 2 doses Measles vaccine, 2 doses of Mumps vaccine, and 1 dose of Rubella vaccine, OR
– Physician documented history of disease
Varicella – Chicken Pox
– Evidence of Varicella Vaccination (2 doses after age 13) OR
– Strong history of disease past infection at 12 months of age or greater as evidenced by: visible scars, strong recollection of disease (verbal history from parents is unacceptable), history of chicken pox/shingles or physician diagnosis of Varicella OR
– Serology indicating Immune status
Hepatitis B Vaccine
– Evidence of 3 doses of Vaccine AND
– Serology indicating Immune status
Tetanus Diphtheria (TD) / Tetanus Diphtheria Pertussis
– Evidence of 1 dose TD within the last 10 years
– One adult dose of Pertussis vaccine (included with Tetanus Diphtheria booster)
It is important you complete these requirements so that your protected status is known, in the event of an exposure or
outbreak. It is your responsibility to meet all the requirements and maintain the documentation should you be asked to provide it.
If you have outstanding immunizations or blood work, you can follow up with your own treating physician or travel clinic to have this done prior to visiting a WHS drop-in clinic which will be accessible to residents as of June 1, 2014.
Revised 17 April 2014

Human Resources
Workplace Health and Safety
Do not e-mail/ fax your documents to our office. Please bring the completed WHS CDA form and immunization records in-person to an Edmonton zone, WHS Health Protection drop in Clinic, for review by an Occupational Health Nurse. If you are having difficulty obtaining your records, you may see the OHN on June 27, 2014,
If you require a TB test, you may have it done during your assessment. A TB read sheet will be provided to you when the TB skin test is administered. It will be your responsibility to have your TB test read within 48- 72 hours by a qualified health care professional.
WHS will have a drop-in clinic open on June 30, 2014 to have your TB test read. If you are unable to have your TB test done at the dates specified, please refer to the WHS drop-in clinic schedule to complete at another date.
To obtain your immunization records, you may need to contact one or more of the following sources:
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The Student Health Services where you have completed your education
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A previous Employer ie.)Covenant Health, etc. (if you were previously an AHS employee, you may obtain your record by faxing a
‘consent to disclosure form’ to WHS @ 780-342-8448; may take up to 2-3 weeks).
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The Public Health Clinic where you grew up
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A Family doctor
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If you were born or received immunizations within the Edmonton and area Region, call 780-413-7985. If you were born in Alberta outside of Edmonton call 1-877-414-2665.
Thank you in advance for your co-operation,
Workplace Health and Safety
Revised 17 April 2014