NNIS Forms

Criteria for Dtermining Nosocomial Pneumonia

Adult and Pediatric Intensive Care Unit (ICU) Monthly Report Form

High Risk Nursery (HRN) Surveillance: Monthly Report Form

Hospital Personnel List

Infection Worksheet

Monthly Surveillance Plan

Antimicrobial Use and Resistance (AUR) Surveillance Component:
 

	Contact List
	Monthly Report Form
	Antimicrobial Agent Prescribing Practices Form

Surgical Patient Surveillance:
 

	Operative Procedure Daily Report Form
	Cesarean Section Patient Report Form
	Craniotomy Patient Report Form
	Spinal Fusion Patient Report Form
	Ventricular Shunt Patient Report Form

Please Note: The above are PDF Files.  You will need, at least version 3.0 of Adobe Acrobat Reader (4.0 preferred).   Acrobat Reader is a free application available for download at the Adobe Website. Click here to download Adobe Acrobat Reader.

A Note about printing:  If you are using Acrobat Reader 4.0 and printing to an HP 3, 4 or 5 series printer your printouts may not look like the original.
Solution: After you select File>Print, in the print dialogue box, select "print as image".