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Moe Shea Corporation Vocational Training Institute It is mandatory that each candidate for the Certified Nursing Assistant receive Tuberculin Screening. This can be done at your local TB clinic or your private physician or clinic. You MUST have a 2-step Mantoux prior to the start of the program. Name: FIRST MANTOUX: Mantoux Given: ___/___/___ Site: L ٱ R ٱ Administered By: Forearm ٱ Lot # Expiration Date: Read By: Results: Neg. ٱ Pos. ٱ mm induration Pos. ٱ mm induration Date: SECOND MANTOUX: Mantoux Given: ___/___/___ Site: L ٱ R ٱ Administered By: Forearm ٱ Lot # Expiration Date: Read By: Results: Neg. ٱ Date: Previous positive skin reaction requires a chest x-ray be done Chest x-ray date: Date: results must be attached