ETA 9217 Lab Testing Information Sheet

U.S. Department of Labor Employment and Training Administration Office of Job Corps

ETA FORM 9217 OMB Control No. 1205-0219 Expiration Date: 05/31/2025

Laboratory Testing Information Sheet

Pre-testing discussion and information provided The Health and Wellness staff are going to talk to you about your health behaviors and risks for certain infections and other health conditions. These questions can feel very personal – mainly when asking about sexual behaviors – but help us know how to best meet your health needs. We ask that you are open and honest. Job Corps requires the following health screening tests for all new students. We screen all arriving students for tuberculosis (TB).
The following tests will be done:
Test		Source
HIV		Blood
Syphilis		Blood
Drug Screen		Urine
Chlamydia		Urine or vaginal swab
Gonorrhea		Urine or vaginal swab
Pregnancy (for students with a uterus)		Urine
Tuberculosis (TB)		Skin test
We will collect small amounts of blood and urine for testing. We will place a skin test for TB screening if you have not had a TB test in the last twelve months. Additional testing may be advised based on the results of the required tests and/or based on your health behaviors.
Do you have any questions or concerns that you would like to discuss at this time?
You will return for a discussion of your test results, and you will have the chance to ask more questions at that time.
Student Acknowledgement of laboratory pre-test counseling: I the undersigned, certify that all information on this form is accurate.
SIGNATURE:	DATE: Click or tap to enter a date.

Post-test counseling and notification I have received the required laboratory test results Enter text.(student initial) I understand the following outcomes: If test results are Positive: A positive urine drug screen test means I must join the Trainee Employee Assistance Program (TEAP) to receive support in abstaining from substance use. A positive pregnancy test means I must talk to the center health and wellness staff about my pregnancy. A positive HIV, Chlamydia, gonorrhea, syphilis, or TB test means I need further medical care for treatment and management. I will meet with the health and wellness staff to discuss treatment and how I can reduce the risk of infecting others. If test results are Negative: I can talk to a health and wellness staff member to discuss how to reduce my future risk for infectious diseases or pregnancy. If I am at high risk for HIV infection, I understand that the health and wellness staff is available to help me reduce my risk of infection and I can schedule to see the medical staff to consider available medications, such as PrEP (Pre-exposure Prophylaxis and PEP (Post-exposure Prophylaxis). PrEP involves taking anti-HIV medication to reduce the risk of becoming infected with HIV when you are exposed to HIV.  PrEP reduces the risk of becoming HIV positive. PEP may be recommended after you have come in contact with HIV, the virus that causes AIDS.  You must start PEP within 3 days after exposure to HIV.
Student Acknowledgement of laboratory post-test counseling: I the undersigned, certify that all information on this form is accurate.
SIGNATURE:	DATE: Click or tap to enter a date.

Paperwork Reduction Act Public Burden Statement: Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Respondents' obligation to complete this form is required to obtain or retain benefits (P.L. 113-128). Public reporting burden is estimated to average 8 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate to the U.S. Department of Labor, Division of Adult Services, Room S-4209, Washington, D.C. 20210 (Paperwork Reduction Project 1205-0035). Please do not submit completed forms to this address.

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