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Tools & Templates

Below are links to tools and templates developed by specific surveillance programs that may be adapted for use by other programs. They include data sharing agreements, evaluation templates, survey questionnaires, slide sets, software, forms, and toolkits.

Click on the arrow ( ) sign to expand the list of documents for the topic areas under the following tools and templates:

Data Sharing Agreements

Examples of program templates for data sharing agreements.

Maternal Health

Evaluation Templates

Examples of evaluation guides, plans, worksheets, and checklists, and program logic models.

Chronic Disease

  • Developing and Using a Logic Model

    Clarify approaches to and methods for evaluation, provide examples specific to the scope and purpose of the state chronic disease programs, and recommend resources for additional reading. Although examples provided in the guides are specific to HDSP programs, the information might also prove valuable to other state health department programs, especially chronic disease programs.

Maternal and Child Health

Survey Questionnaires

Examples of CDC surveys and questionnaires.

Health and Nutrition

  • National Health and Nutrition Examination Survey (NHANES)

    A program of studies designed to assess the health and nutritional status of adults and children in the United States. The NHANES interview includes demographic, socioeconomic, dietary, and health-related questions. The examination component consists of medical, dental, and physiological measurements, as well as laboratory tests administered by highly trained medical personnel.

Health Risk Behavior

Maternal and Child Health


Examples of CDC computer-based programs and applications for surveillance activities.

Chronic Disease


  • CDC EZ-Text
    Software program developed to assist researchers create, manage, and analyze semi-structured qualitative databases.
  • Epi Info
    Suite of lightweight software tools, delivers core ad-hoc epidemiologic functionality without the complexity or expense of large, enterprise applications. Includes easy form and database construction, data entry, and analysis with epidemiologic statistics, maps, and graphs.

Occupational Health

  • SPIDER Database Software

    Software that is capable of collecting, managing, and reporting in a standardized fashion all pertinent information needed by NIOSH and US EPA to conduct surveillance on acute pesticide-related illness.

Surveillance Forms

Examples of data collection forms and checklists.

Emergency Response and Preparedness

  • CDC Shelter Assessment Tool

    Assessment form assists environmental health practitioners in conducting a rapid assessment of shelter conditions during emergencies and disasters. It covers 14 general areas of environmental health, ranging from basic food safety and water quality to pet wellness, and allows for the documentation of immediate needs in shelters. Can be easily modified to meet local needs.

  • Public Health Assessment and Surveillance after a Disaster — Mortality and morbidity surveillance forms

    Host of mortality and morbidity surveillance forms (e.g., Disaster-Related Mortality Surveillance Form, Disaster-Related Mortality Surveillance Instruction Form; Natural Disaster Morbidity Surveillance Individual Form Natural Disaster Morbidity Surveillance Line List Natural Disaster Morbidity Surveillance Tally Sheet Natural Disaster Morbidity Surveillance Summary Report Form). These forms are not meant to replace normal patient triage and record keeping or routine surveillance reporting mechanisms.

Occupational Health

  • Field Investigation Contact Form and Health Safety Checklist for Field Personnel 

    Checklist is designed to remind field staff about equipment and safety precautions they need to take when embarking on a field investigation or any form of on-site follow-up.

  • Main Pesticide Exposure Questionnaire 

    Sample questionnaire for use by an acute pesticide-related illness and injury surveillance program. It includes questions that satisfy the data requirements for all of the core variables needed by CDC’s National Institute for Occupational Safety and Health. States will need to customize this questionnaire for their specific needs.

  • Pesticide Case Tracking Checklist and Contact Log 

    Two forms are examples of mechanisms that pesticide poisoning surveillance programs can use to track the case follow-up process to ensure that all needed information is collected and that appropriate referrals and agency contacts are made.

  • Pesticide Illness and Injury Surveillance Data Collection Form 

    Sample data collection form for use by an acute pesticide-related illness and injury surveillance program. This data collection form is for states that choose not to use a standard questionnaire but collect data via an open-ended interview. States will need to customize this data collection form for their specific needs.


Examples of CDC toolkits, which are a collection of information, resources, tools, and advice for a specific subject area or activity.


Emergency Response and Preparedness


  • Injury Surveillance Training Manual (Instructor Guide and Participant Guide)
    Steps needed to establish and maintain an injury surveillance system; provides information on designing and monitoring prevention activities; and offers guidance for making informed decisions about injury prevention. Designed primarily for professionals who develop or operate surveillance systems and conduct prevention activities in less-resourced countries.