Disease / Condition-Specific Forms

Acute Flaccid Myelitis​
Meningitis (Bacterial)
Anthrax
Meningococcal Disease 
Babesiosis​​
Meningococcal Disease Supplemental Form​
Botulism Infant MERS-CoV (PDF)
Brucellosis MERS-CoV (Word)
Carbapenem-resistant Organisms (CRO)​ Mumps 
Chlamydia​ Outbreak (See below)
Cholera and Other Vibrio Illnesses  (Form Guidance) Pertussis
Cronobacter​
Pneumonia in a Health Care Worker
Cyclosporiasis
Polio
Dengue
Psittacosis
Diphtheria
Q-Fever
Encephalitis
Rubella
Gastroenteritis ​​(Click Here for Instructions)
Rubella - Congenital
Gonorrhea​
SARS
Haemophilus Influenzae
Smallpox
Hansen's Disease (Leprosy)
Streptococcus - Group A
Hantavirus
Streptococcus - Group B
Hepatitis A Acute
Syphilis
Hepatitis B Acute
Tetanus
Perinatal Hepatitis B 
Tickborne Rickettsial (RMSF/Ehrlichiosis/Anaplasmosis)
Perinatal Hepatitis B Contact
Toxic Shock Syndrome
Hepatitis C (Initial)
Trichinosis
Hepatitis C (Supplemental)
Tularemia
Influenza, Novel 
Typhoid and Paratyphoid Fever
Influenza-Associated Pediatric Death
Vaccine Adverse Event Reporting System (VAERS)
Kawasaki Syndrome
Varicella
Legionellosis - Case Report Form
Varicella Death Investigation
Legionellosis - Supplemental Questionnaire 
Varicella Death Guidelines
Leptospirosis
Vibrio (Form Guidance)
Listeria Initiative
Viral Hemorrhagic Fever (VH​​F)
Malaria​​
West Nile Virus
Measles
Zika Virus
Meningitis (Aseptic)

Long-Term Care Facility Forms Adobe
Acrobat
Microsoft
Word
​COVID-19 Outbreak (any facility type) PDF
Gastroenteritis Outbreak (use for all facility types)
P​DF

Respiratory Outbreak PDF Word
Scabies Outbreak PDF Word
Drug Resistant Organism Outbreak PDF Word
     
Foodborne Outbreak Forms    
     
National Outbreak Reporting System (NORS) Form 52.13
PDF
National Outbreak Reporting System (NORS) Form 52.13 Guidance PDF  
NORS Guidance Appendices:
 
​​Appendix A: Mode of Transmission for Certain Beverages and Foods or Drinks Containing Ice
PDF
​Appendix B: Reporting Foodborne and Animal Contact Multistate Exposure and Residency Outbreaks
PDF
​​Appendix C: Freedom of Information Act (FOIA) Requests and Other Requests for NORS Data
PDF
​​Appendix D: ​NORS Guidance for Contributing Factors (CF) in Foodborne Outbreak Reports
PDF
​​Appendix E: Available Picklist Values    ​ 
PDF
     
Other Forms    
     
​COVID-19 Outbreak (any facility type) PDF
Daycare Facility Outbreak (excluding gastroenteritis)
PDF Word
Hospital Outbreak (excluding gastroenteritis) PDF Word
Gastroenteritis Outbreak (use for all facility types)
P​DF


Pertussis Outbreak PDF
Word​
School Outbreak (General)
School Outbreak (Influenza or ILI)
PDF
PDF
Word
Word
Waterborne Illness Outbreak PDF Word