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-D E-I L-Q R-Z
A-D
- Acute Flaccid Myelitis (AFM) Case Investigation Form (PDF, 863 KB, January 2020)
- 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 Forms
- 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 (Doc or PDF)
- Coronavirus Forms
- Coronavirus, Novel; 2019 Novel Coronavirus
(2019-nCoV) - Patient Under Investigation (PUI) Form (PDF, 2.7 MB, April 2020)
- 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 Forms
- 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 Forms
- 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 B, Perinatal Case Management Forms
- 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)
- Hookworm Case Investigation Form (PDF, 95 KB, February 2016)
- Hypothesis Generating Questionnaire for Gastroenteritis Complaints (PDF, 17.68 KB, April 1999)
- Influenza Forms
- 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 Forms
- 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 Forms
- 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 (PDF, 668 KB, September 2019)
- Paragonimiasis Case Investigation Form (PDF, 96 KB, February 2016)
- Pertussis Forms
- 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 Forms
- 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)
- 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 Forms
- Varicella (Chickenpox) Reporting Form (PDF, 329 KB, September 2019)
- Varicella Death Investigation Form (PDF, 91 KB, May 2005)
- Vibriosis Forms
- Vibriosis Case Investigation Form (PDF, 697 KB, June 2017)
- Vibriosis/COVIS Form 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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