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Infectious Disease Control Investigation forms

Alphabetical Listing of Investigation Forms              
Click on the link to view or download the form

A-C      E-I      L-Q      R-W

A-D

  • Acute Flaccid Myelitis (AFM) (.doc, 75.9 KB, September 2015)
  • Amebic Meningitis/Encephalitis Case Report Form (Free-Living Ameba Case Report Form, PDF, 163 KB, January 2012)
  • Anthrax Case Investigation Form (PDF, 18 KB, August 2004)
  • Arboviral Case Investigation Form (PDF, 106 KB, December 2015)
  • Ascariasis Investigation Form (PDF, 95 KB, Feb 16, 2016)
  • Babesiosis Case Report Form (PDF, 658 KB, June 2013)
  • Botulism Forms
    Foodborne Investigation Form (PDF, 18 KB, May 16, 2007)  
    Infant Investigation Form (PDF, 20 KB, May 16, 2007)
    Control Measure Tracking Form Botulism (PDF, 74KB, December 2011)
  • Brucellosis Case Investigation Form (PDF, 61.2 KB, January 2015)
  • Chagas’ Disease Case Investigation Form (PDF, 47 KB, June 2013)
  • Cholera Surveillance Form, August 2008 revision (PDF, 140 KB, August 2007)
  • Communicable Disease Reporting Forms
    EPI-1 (PDF, 78.3 KB, August 2015)
    EPI-2 (PDF, 66.6 KB, August 2015)
  • Contaminated Sharps Injury Reporting Forms
  • Coronavirus, Novel; Middle East Respiratory Syndrome (MERS) – Patient Under Investigation (PUI) Short Form (PDF, 192 KB, December2015)
  • CRE Investigation Form (PDF, January 15, 2016)
  • Cyclosporiasis Investigation Form (PDF, 147 KB, July 2014)
  • Dengue Case Investigation Form (PDF, 104 KB, December 2015)

 

E-I

  • Ebola Virus Investigation Form, CDC ( PDF, 219 KB, November 11, 2014)
  • Echinococcosis Investigation Form ( PDF, 42 KB, January 11, 2016)
  • Escherichia coli O157:H7 and Hemolytic Uremic Syndrome Investigation Form, (PDF, 205 KB, September, 2014) 
  • Escherichia coli O157:H7 Food History Listing Form (PDF, 62 KB)
    Control Measure Tracking Form E coli STEC (PDF, 82KB, December 2011)
  • Fascioliasis Investigation Form (PDF, 94 KB, February 16, 2016)
  • Foodborne Outbreak Investigation Form (PDF, 146 KB, March 2008)
  • Haemophilus influenzae Investigation Form (PDF, December 2015)
  • Hansen's Disease Investigation Forms
  • Hantavirus Pulmonary Syndrome Form, CDC (PDF, 187 KB, May 2010)
  • Hepatitis A Investigation Form (Viral Hepatitis Case Tracking Form)  PDF, 212 KB, May 2014
    Control Measure Tracking Form HAV (PDF, 82KB, December 2011)
  • Hepatitis B Investigation Form (Viral Hepatitis Case Tracking Form)  PDF, 212 KB, May 2014
  • Hepatitis C Investigation Form (Viral Hepatitis Case Tracking Form)  PDF, 212 KB, May 2014
  • Hepatitis E Investigation Form (Viral Hepatitis Case Tracking Form)  PDF, 212 KB, May 2014
    Hepatitis B, Perinatal
  • Hookworm Investigation Form (PDF, 95 KB, February 16, 2016)
  • Hypothesis Generating Questionnaire for Gastroenteritis Complaints (PDF, 17.68 KB, April 14, 1999)
  • Influenza-Associated Pediatric Death Investigation FormForm Instructions (PDF, September, 2013)
  • Influenza, General Investigation Form (PDF, 35 KB, September, 2011)
  • Influenza, Supplemental Investigation Questions (PDF, 42 KB, September, 2011)

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L-Q

  • Legionellosis Investigation Report Form , April 2002 revision (PDF, 32 KB, September, 2011) 
  • Leishmaniasis Case Investigation Form (PDF, 51 KB, June 2013) 
  • Listeria Case (with supplemental medical history form) Form, CDC (PDF, 197 KB) 
  • Lyme Case Investigation Form (PDF, 74 KB, October 2013)
  • Malaria Investigation Form, CDC (PDF, 118 KB)
  • MDR-A Investigation Form (PDF, January 15, 2016)
  • Measles (Rash-Fever) Investigation Form (PDF, November 2012)
    Control Measure Tracking Form Measles (PDF, 84KB, December 2011)
  • Meningococcal (Neisseria Meningitidis) Investigation Form (PDF, 194 KB, May 2014) 
  • Mumps Investigation Form (PDF, 34.3KB, March 2013)
  • Paragonimiasis Investigation Form (PDF, 96 KB, Feb 16, 2016)
  • Pertussis Investigation Form (WORD, December, 2013)
  • Pertussis Death Investigation Form, CDC (PDF
  • Plague Case Investigation Form (PDF, 67.0 KB, November 2004)
  • Q Fever Investigation Form (PDF, 62.7 KB, August 2004)

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R-W

  • Rash-Fever Illness Case Track Record (PDF, November 2012)
  • Respiratory Disease Contact Tracking Form (PDF, 30 KB September 2011)
  • Respiratory Disease Outbreak Summary Form (PDF, September 2011)
  • Rickettsial Disease Case Investigation Form  (PDF, 16 KB, May 2006)
    Used for Anaplasmosis, Ehrlichiosis, Typhus, and Spotted Fever Group Rickettsiosis
  • Rubella (Rash-Fever) Investigation Form (PDF, 98.4 KB, May 2008)
  • Smallpox Investigation Forms, CDC 
    Evaluating Patients for Smallpox (PDF, 182 KB, March 4, 2002)
    Post Event Surveillance Form (PDF, 147 KB, June 2003)
  • Streptococcal Investigation Form (PDF, 35 KB, July, 2015) 
  • Taenia Tapeworm Investigation Form (PDF link, 53.4 KB, April 2007)
  • Tetanus Investigation Form (PDF, 150 KB, May 2014)
  • Tick-borne Relapsing Fever Case Investigation Form (PDF, 54.4 KB, August 2004)
  • Trichinosis Case Report Form (PDF, 30 KB, June 2013)
  • Trichuriasis Investigation Form (PDF, 30 KB, Feb 16, 2016)
  • Tuberculosis Forms (including Report of Case and Patient Services, November 2003)
  • Tularemia Case Investigation Form (PDF, 62.1 KB, August 2004)
    Control Measure Tracking Form Tularemia (PDF, 20KB, December 2011)
  • Typhoid Fever Surveillance Report, CDC (PDF, 86 KB, April 2009)
  • Varicella (Chickenpox)  Reporting Form  (PDF, June 2012)
  • Varicella (Chickenpox)  Outbreak Form  ( PDF, 101 KB, 2015) 
  • Varicella Death Investigation Form, CDC  (PDF, 91 KB, May 9, 2005)
  • Vibriosis Surveillance Form, August 2008 revision   (PDF, 140 KB, August 2008)
  • Viral Gastroenteritis Outbreak Reporting Form (PDF, 655 KB, February 2004)
  • Viral Hepatitis Case Tracking Form (PDF, March 2013)
  • VRSA/VISA Case Report Form (PDF, 65 KB, January 3, 2011)
  • Yersiniosis Case Investigation Form, 1998 revision (PDF, 13 KB, May 16, 2007)
  • Waterborne Disease Outbreak Reporting Form (PDF, 87 KB)
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