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This form is used to report all reportable diseases in child care facilities or schools, ensuring public health follow-up in accordance with the Health Protection and Promotion Act.
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How to fill out Child Care Facility/School Reportable Disease Reporting Form
01
Obtain the Child Care Facility/School Reportable Disease Reporting Form from the appropriate health department or educational authority.
02
Fill in the name and address of the child care facility or school at the top of the form.
03
Provide the date of the report submission.
04
Identify the reported disease by checking the appropriate box or filling in the name of the disease.
05
List the number of confirmed cases reported.
06
Include the names, ages, and contact information of the affected individuals, if required.
07
Specify the date of onset for each case.
08
Attach any additional documentation or information as needed.
09
Sign and date the form to certify the information provided is accurate.
10
Submit the completed form to the designated health authority or agency.
Who needs Child Care Facility/School Reportable Disease Reporting Form?
01
Child care facilities and schools that have reported cases of communicable diseases among their students or attendees are required to use the reporting form.
02
Healthcare providers may also need the form to report cases of reportable diseases related to children in child care or school settings.
03
Parents or guardians may need to fill out the form under specific circumstances related to outbreaks or reporting duties.
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People Also Ask about
How do I report a communicable disease in Maricopa County?
To report a communicable disease or outbreak, please call 602-506-6767.
What is a reportable condition?
Notifiable diseases are diseases that must be reported to government health authorities. Reporting helps prevent and manage outbreaks. Your doctor must tell your state or territory department of health if you are diagnosed with a notifiable disease.
What is an example of a reportable disease?
Mandatory written reporting: A report of the disease must be made in writing. Examples are gonorrhea and salmonellosis. Mandatory reporting by telephone: The provider must make a report by phone. Examples are rubeola (measles) and pertussis (whooping cough).
What are examples of reportable diseases?
Diseases reportable to the CDC include: Anthrax. Arboviral diseases (diseases caused by viruses spread by mosquitoes, sandflies, ticks, etc.) such as West Nile virus, eastern and western equine encephalitis. Babesiosis. Botulism. Brucellosis. Campylobacteriosis. Cancer. Candida auris, clinical.
What is a reportable list?
The reportable list identifies malignancies with a behavior code (fifth digit) of 2 or 3 as identified in the International Classification of Diseases for Oncology, 3rd edition (ICD-O-3).
How do I report a communicable disease in NYC?
In New York City, call 1 (866) NYC-DOH1 (1-866-692-3641) for additional information. Health care personnel in New York City should use the downloadable Universal Reporting Form (PD-16) ; those belonging to NYC MED can complete and submit the form online .
What are the 20 common communicable diseases?
Chickenpox (Varicella) Chikungunya. Coronaviruses (COVID-19) Cytomegalovirus (CMV) Dengue. Diphtheria. Ebola. Hepatitis. Hib Disease. /AIDS. HPV (Human Papillomavirus) Japanese Encephalitis. Measles. Meningococcal Disease. Mpox. Mumps. Norovirus. Polio. Rabies. Rotavirus. Rubella. Tuberculosis (TB) Whooping Cough (Pertussis) Zika.
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What is Child Care Facility/School Reportable Disease Reporting Form?
The Child Care Facility/School Reportable Disease Reporting Form is a standardized document used to report cases of communicable diseases that occur within child care settings or schools to health authorities.
Who is required to file Child Care Facility/School Reportable Disease Reporting Form?
Child care providers, school administrators, and designated personnel in educational institutions are required to file the form when they identify reportable diseases among students or staff.
How to fill out Child Care Facility/School Reportable Disease Reporting Form?
To fill out the form, you should collect information on the affected individual, including their name, age, and type of disease, as well as details about the outbreak, such as dates of symptoms and any preventive measures taken.
What is the purpose of Child Care Facility/School Reportable Disease Reporting Form?
The purpose of the form is to ensure timely reporting of communicable diseases to public health authorities to facilitate monitoring, investigation, and control measures in order to prevent outbreaks and protect public health.
What information must be reported on Child Care Facility/School Reportable Disease Reporting Form?
Information that must be reported includes the name and details of the affected individual, the type of reportable disease, dates of onset and symptoms, and any relevant contact or exposure history.
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