Disease / Condition-Specific Forms

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

​​Histoplasmosis




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