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.
|MS Word||8.5" x 11" [66 KB]||Standard page size; suitable for electronic entry|
|Adobe PDF||8.5" x 11" [11 KB]||Standard page size; suitable for hand entry|
|MS Word||8" x 14" [66 KB]||Suitable for hand or electronic entry|
|Adobe PDF||8" x 14"||Suitable for hand or electronic entry|
|MS Word||A4 [66 KB]||European format|
|Adobe PDF||A4||European format|
|MS Word||11" x 17"||Large size for electronic entry|
|Adobe PDF||11" x 17"||Large size for hand entry|
Sample Standard Food and Activities History Questionnaire [DOC - 179 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 the VSP Operations Manual 2005, Appendix 13.2, pages 164-5.
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.