Disease / Condition-Specific Forms

Acute Flaccid Myelitis​
Influenza, Novel 
Tickborne Rickettsial (RMSF/Ehrlichiosis/Anaplasmosis)
Anthrax
Influenza-Associated Pediatric Death
Toxic Shock Syndrome
Babesiosis​​
Kawasaki Syndrome
Trichinosis
​Blastomycosis
Legionellosis 
Tularemia
Botulism Infant
Leptospirosis
Typhoid and Paratyphoid Fever
Brucellosis
Listeria Initiative
Vaccine Adverse Event Reporting System (VAERS)
Carbapenem-resistant Organisms (CRO)​
Malaria
Varicella
Chlamydia​
Measles
Varicella Death Investigation (Form Guidance)
Cholera and Other Vibrio Illnesses  (Form Guidance)
Meningitis (Aseptic)
Vibrio (Form Guidance)
Cocciodioidomycosis
Meningitis (Bacterial)
Viral Hemorrhagic Fever (VH​​F)
​​Cronobacter
Meningococcal Disease
West Nile Virus
Cyclosporiasis
Meningococcal Disease Supplemental Form​
Zika Virus​
Dengue
MERS-CoV (Word)

Diphtheria
Mumps 

Encephalitis
Outbreak (See below)

Gastroenteritis ​​(Click Here for Instructions)
Pertussis​

Gonorrhea​
Pneumonia in a Health Care Worker

Haemophilus Influenzae
Polio
Hansen's Disease (Leprosy)
Psittacosis
Hantavirus
Q-Fever
Hepatitis A Acute
Rubella
Hepatitis B Acute
S​ARS
Perinatal Hepatitis B 
Smallpox
Perinatal Hepatitis B Contact
Streptococcus - Group A
Hepatitis C (Initial)
Streptococcus - Group B
Hepatitis C (Supplemental)
Syphilis
​​Histoplasmosis
Tetanus




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