Disease Outbreak Investigation Form
General Information
Investigation Date
Investigator Name
Disease/Condition
Location
Case/Outbreak ID
Description of Outbreak
Date of Onset (First Case)
Total Number of Cases
Total Number of Deaths
Description
Population at Risk
Estimated Population Exposed
Population Description
Case Definition
Case Definition Used
Confirmed Cases
Probable Cases
Suspect Cases
Clinical Information
Common Symptoms
Laboratory Tests Performed
Control Measures
Measures Implemented
Additional Actions Needed
Comments/Notes
Additional Information