Introduction Exposure to respirable crystalline silica is known to increase the risk of progression to active tuberculosis (TB) disease in those who have latent TB infection. Both latent TB infection and active TB disease are relevant components of screening examinations in silica-exposed workers.

Methods Health care providers screening silica-exposed workers for TB must generally:

• identify for further evaluation and treatment any employees with suspected active TB disease

• adhere to safety and health regulatory requirements, when applicable

• even when regulations do not require screening, exercise sound screening practices in workers who stand to benefit from medical evaluations

• be familiar with current peer–reviewed publications; specialty society recommendations; national and state public health policy approaches

• coordinate with local approaches to TB screening

• incorporate both occupational and non–occupational health indications into screening decisions.

Using a publicly-funded, transparent, and democratic process, the Department of Labour and Industries has developed a TB risk assessment and testing algorithm for adult workers exposed to respirable crystalline silica.

The screening tool integrates these varied needs and resources into a cohesive document for use at the point of health care delivery.

Result The tool is a clinical adjunct that helps health care providers make two key decisions when evaluating patients with exposure to respirable crystalline silica:

1. Which workers should undergo a comprehensive evaluation for active tuberculosis disease?

2. Which workers should receive testing for latent TB infection?

Discussion Widespread availability of the risk assessment and testing algorithm is assured through direct inclusion in Washington State regulatory documents. The tool integrates medical content and public policy for clinicians performing the TB screening in silica-exposed workers through a single, accessible form. As a freely-available clinical aid, it is available to clinicians performing TB screening in silica-exposed workers throughout the United States, and worldwide.