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, 380 KB, May 2021)
- 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, 1.45 MB, September 2022)
- 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)
- Candida auris Disease Case Investigation Form (PDF, 763, last updated January 2021)
- Chagas Disease Case Investigation Form (PDF, 1.1 MB, June 2023)
- Cholera Forms
- Cholera Case Investigation eForm (PDF, 697 KB, June 2017)
- Instructions for Reporting to the Cholera and Other Vibrio Illness (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
- CRE Case Investigation Form (PDF, 169 KB, January 2016)
- Cyclosporiasis Case Investigation Form (PDF, 1.5 MB, May 2022)
- Dengue Case Investigation Form (PDF, 1.8 MB, September 2022)
E-I
- Ebola Virus Case Investigation Form (PDF, 219 KB, November 2014)
- Echinococcosis Case Investigation Form (PDF, 42 KB, January 2016)
- Escherichia Forms
- Shiga toxin-producing Escherichia coli (E. coli) and Hemolytic Uremic Syndrome (HUS) Case Investigation Form (PDF, 593 KB, September 2014)
- PHEP Surveillance Control Measure Tracking Form - Shiga toxin-producing Escherichia coli (STEC) (PDF, 135 KB, December 2011)
- E coli STEC Control Measure Tracking Form (PDF, 135 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, 382 KB, March 2021)
- Hansen's Disease Forms
- Hantavirus Pulmonary Syndrome Case Investigation eForm (PDF, 199 KB, November 2022)
- Hepatitis Forms
- Hepatitis A Case Investigation Form (PDF, 675 KB, December 2021)
- HAV Control Measure Tracking Form (PDF, 82 KB, December 2011)
- Hepatitis B Case Investigation Form (PDF, 647 KB, January 2022)
- 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)
Return to the Top of the Page
L-Q
- Legionellosis Case Investigation Form (PDF, 823 KB, January 2018)
- Leishmaniasis Case Investigation Form (PDF, 961 KB, June 2023)
- Listeria Forms
- Lyme Disease Case Investigation Form (PDF, 851 KB, March 2022)
- Malaria Case Investigation Form (PDF, 453 KB, March 2022)
- 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/Rubella Contact Tracing Form (PDF, 274 KB, July 2022)
- Meningococcal (Neisseria Meningitidis) Case Investigation Form (PDF, 752 KB,
September 2019)
- Mumps Case Investigation Form (PDF, 853 KB, July 2022)
- Mumps Outbreak Report Form (PDF, 297 KB, March 2021)
- Paragonimiasis Case Investigation Form (PDF, 96 KB, February 2016)
- Pertussis Forms
- Pertussis Case Investigation Form (PDF, 507 KB, July 2022)
- 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, 805 KB, November 2022)
Return to the Top of the Page
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, 997 KB, November 2022)
Used for Anaplasmosis, Ehrlichiosis, Typhus, and Spotted Fever Group Rickettsiosis
- Rubella/Measles (Rash-Fever) Case Investigation Form (PDF, 652 KB, September 2019)
- Streptococcus pneumoniae, invasive Case Investigation Form (PDF, 347 KB,
September 2019)
- Taenia/Cysticercosis Case Investigation Form (PDF, 53.4 KB, April 2007)
- Tetanus Case Investigation Form (PDF, 557 KB, October 2021)
- Tick-borne Relapsing Fever Form (PDF, 145 KB, November 2020)
- 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, 459 KB, September 2022)
- Varicella Forms
- Varicella (Chickenpox) Reporting Form (PDF, 414 KB, August 2023)
- Varicella Outbreak Report Form (PDF, 204 KB, March 2021)
- Varicella Death Investigation Form (PDF, 91 KB, May 2005)
- Vibriosis Forms
- Vibriosis Case Investigation Form (PDF, 3 MB, May 2018)
- 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)
Return to the Top of the Page