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OPRP - Forms

Sample GI Surveillance Logs
The sample GI logs are based on the requirements set forth in the VSP Operations Manual 2005, Annex 13.2, page 163, and include all symptoms that are a part of the operational case definition.

FormatDimensionsComments
MS Word8.5" x 11" [66 KB]Standard page size; suitable for electronic entry
Adobe PDF8.5" x 11" [11 KB]Standard page size; suitable for hand entry
MS Word8" x 14" [66 KB]Suitable for hand or electronic entry
Adobe PDF8" x 14"Suitable for hand or electronic entry
MS WordA4 [66 KB]European format
Adobe PDFA4European format
MS Word11" x 17"Large size for electronic entry
Adobe PDF11" x 17"Large size for hand entry

Sample Standard Food and Activities History Questionnaire [PDF - 775 KB]
A sample of the food and activities questionnaire to be completed by all passengers and crew members with symptoms of acute gastroenteritis. This form is also found in section 13.2.2 of the VSP 2011 Operations Manual.

CDC Epi Form for Cruise Ships [PDF - 284 KB]
This form is to be used when submitting clinical specimens to the CDC Bacterial or Viral Labs.

Sample GI Illness Public Incidence Response Log [DOC - 40 KB]
A sample of a log used to track public incidence of diarrhea or vomiting responses on board cruise ships. The data captured by this form have proven useful in some acute gastroenteritis outbreak investigations.


 
 
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