IDCU Investigation Forms

Investigation Forms

IDCU Home Investigation Guidance

Alphabetical Listing of

Case Investigation Form
Outbreak Investigation Form
Death Investigation Form
Control Measure Tracking Form
Reporting Form
Miscellaneous – Food History, Hypothesis Generating, etc.

Click on the link to view or download the form.

A-C E-I L-Q R-Z

A-D

Acute Flaccid Myelitis (AFM) Case Investigation Form (PDF, 952 KB, March 2019)
Amebic Meningitis/Encephalitis Case Investigation Form (PDF, 163 KB, January 2012)
Anthrax Case Investigation Form (PDF, 18 KB, August 2004)
Arboviral Case Investigation Form (PDF, 315 KB, August 2018)
Ascariasis Case Investigation Form (PDF, 95 KB, February 2016)
Babesiosis Case Investigation eForm (PDF, 658 KB, June 2013)
Botulism Forms
Botulism Foodborne Case Investigation Form (PDF, 298 KB, May 2019)
Botulism Infant Case Investigation Form (PDF, 334 KB, May 2019)
Botulism Control Measure Tracking Form (PDF, 74 KB, December 2011)
Brucellosis Case Investigation Form (PDF, 184 KB, February 2018)
Brucellosis Lab Exposure Questionnaire (PDF, 367 KB, February 2018)
Chagas Disease Case Investigation Form (PDF, 47 KB, June 2013)
Cholera Case Investigation eForm (PDF, 697 KB, June 2017) Guidance (PDF, 436 KB, June 2017)
Communicable Disease Reporting Forms
EPI-1 Infectious Disease Reporting Form (multiple) (PDF, 78.3 KB, January 2017)
EPI-2 Infectious Disease Reporting Form (single) (PDF, 66.6 KB, January 2017)
Contaminated Sharps Injury Reporting eForm; Contaminated Sharps Injury Reporting Form (PDF, 107 KB, July 2000)
Coronavirus, Novel; Middle East Respiratory Syndrome (MERS) – Case Investigation Form (PDF, 192 KB, December 2015)
CRE Case Investigation Form (PDF, 169 KB, January 2016)
Cyclosporiasis Case Investigation Form (PDF, 1 MB, May 2018)
Dengue Case Investigation Form (PDF, 364 KB, August 2018)

E-I

Ebola Virus Case Investigation Form (PDF, 219 KB, November 2014)

Echinococcosis Case Investigation Form (PDF, 42 KB, January 2016)

Escherichia coli O157:H7 and Hemolytic Uremic Syndrome Case Investigation Form, (PDF, 941 KB, September 2014)
Escherichia coli O157:H7 Food History Listing Form (PDF, 62 KB)
E coli STEC Control Measure Tracking Form (PDF, 82 KB, December 2011)
Fascioliasis Case Investigation Form (PDF, 94 KB, February 2016)
Foodborne Outbreak Investigation Form (PDF, 146 KB, March 2008)
Haemophilus influenzae Case Investigation Form (PDF, 157 KB, December 2015)
Hansen's Disease Forms
Hantavirus Pulmonary Syndrome Case Investigation eForm (PDF, 187 KB, May 2010)
Hepatitis A Case Investigation Form (PDF, 728 KB, March 2019)
HAV Control Measure Tracking Form (PDF, 82 KB, December 2011)
Hepatitis B Case Investigation Form (PDF, 482 KB, September 2019)
Hepatitis C Case Investigation Form (PDF, 212 KB, May 2014)
Hepatitis E Case Investigation Form (PDF, 212 KB, May 2014)
Viral Hepatitis Case Investigation eForm ( Word, 226 KB, May 2016)
Hepatitis B, Perinatal Case Management Forms
Hookworm Case Investigation Form (PDF, 95 KB, February 2016)
Hypothesis Generating Questionnaire for Gastroenteritis Complaints (PDF, 17.68 KB, April 1999)
Influenza-Associated Pediatric Death Investigation Form, (PDF, 133 KB, July 2016) Form Instructions (PDF, 171 KB, July 2016)
Influenza, General Case Investigation Form (PDF, 35 KB, September 2011)
Influenza, Supplemental Investigation Questions (PDF, 42 KB, September 2011)

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L-Q

Legionellosis Case Investigation Form (PDF, 823 KB, January 2018)
Leishmaniasis Case Investigation Form (PDF, 51 KB, June 2013)
Listeria Case Investigation Form, (English version PDF, 325 KB, April 2016.
Spanish version PDF, 260 KB June 2018.)
Lyme Disease Case Investigation Form (PDF, 99 KB, August 2019)
Malaria Case Investigation Form (PDF, 118 KB, January 2016)
MDR-A Case Investigation Form (PDF, 175 KB, January 2016)
Measles/Rubella (Rash-Fever) Case Investigation Form (PDF, 652 KB, September 2019)
Measles Control Measure Tracking Form (PDF, 84 KB, December 2011)
Measles Contact Tracing Form (PDF, 267 KB, September 2019)
Streptococcus pneumoniae, invasive Case Investigation Form (PDF, 347 KB, September 2019)
Meningococcal (Neisseria Meningitidis) Case Investigation Form (PDF, 752 KB, September 2019)
Mumps Case Investigation Form (P DF, 668 KB, September 2019)
Paragonimiasis Case Investigation Form (PDF, 96 KB, February 2016)
Pertussis Case Investigation Form (PDF, 473 KB, September 2019)
Pertussis Death Investigation Form, (PDF, 549 KB, September 2019)
Plague Case Investigation Form (PDF, 67.0 KB, November 2004)
Q Fever Case Investigation Form (PDF, 62.7 KB, August 2004)

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R-Z

Respiratory Disease Contact Tracking Form (PDF, 30 KB September 2011)
Respiratory Disease Outbreak Summary Form (PDF, 784 KB, September 2011)
Rickettsial Disease Case Investigation Form (PDF, 323 KB, May 2019)
Used for Anaplasmosis, Ehrlichiosis, Typhus, and Spotted Fever Group Rickettsiosis
Rubella/Measles (Rash-Fever) Case Investigation Form (PDF, 652 KB, September 2019)
Smallpox Investigation Forms
Evaluating Patients for Smallpox (PDF)
Post Event Surveillance Form (PDF)
Streptococcal Case Investigation Form (PDF, 35 KB, July 2015)
Taenia/Cysticercosis Case Investigation Form (PDF, 53.4 KB, April 2007)
Tetanus Case Investigation Form (PDF, 150 KB, May 2014)
Trichinosis Case Investigation Form (PDF, 30 KB, June 2013)
Trichuriasis Case Investigation Form (PDF, 30 KB, February 2016)
Tuberculosis Forms (See Reporting table.)
Tularemia Case Investigation Form (PDF, 88 KB, October 2017)
Typhoid Fever Case Investigation eForm (PDF, 86 KB, April 2009)
Varicella (Chickenpox) Reporting Form (PDF, 329 KB, September 2019)
Varicella Death Investigation Form (PDF, 91 KB, May 2005)
Vibriosis Case Investigation Form (PDF, 697 KB, June 2017) Guidance, (PDF, 697 KB, June 2017)
VRSA/VISA Case Investigation Form (PDF, 65 KB, January 2011)
Yersiniosis Case Investigation Form, 1998 revision (PDF, 13 KB, May 2007)
Waterborne Disease Outbreak Reporting Form (PDF, 87 KB, May 2008)
Zika Case Investigation Form (PDF, 190 KB, May 2017)

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