Investigation Forms

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
  • COVID-19 Case Report Form (DSHS) (PDF, V.4.0, updated 1/30/2021)
  • Multisystem Inflammatory Syndrome Associated with COVID-19 Case Report Form (CDC) (updated 7/14/2022)
  • 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, 1.5 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)

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L-Q

• Legionellosis Case Investigation Form (PDF, 823 KB, January 2018) 
• Leishmaniasis Case Investigation Form (PDF, 961 KB, June 2023) 
• Listeria Forms
  • Listeria Initiative Case Report Form (English version PDF, 4.5 MB, December 2019)
  • Listeria Initiative Case Report Form (Spanish version PDF, 260 KB June 2018)
• 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)

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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, 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)

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