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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.

View or Download Forms

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, 1.3 MB, January 2024)
    • 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, 165 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, 144 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
  • 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, 169 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, 1.6 MB, November 2023)
    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, 534 KB, December 2023)
  • Taeniasis/Cysticercosis Case Investigation Form (PDF, 1.9 MB, January 2024)
  • 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, 167 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)