Sample GI Surveillance Logs (various sizes and formats)
The sample GI logs are based on the requirements set forth in the VSP Operations
Manual - 2005 Annex 13.2, page 163 and includes all symptoms that are a part of
the operational case definition.
Format | Dimensions | Comments |
MS Word | 8.5" x 11" | Standard page size. Suitable for electronic entry |
Adobe pdf | 8.5" x 11" | Standard page size. Suitable for hand entry |
MS Word | 8" x 14" | Suitable for hand or electronic entry |
Adobe pdf | 8" x 14" | Suitable for hand or electronic entry |
MS Word | A4 | 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
(MS Word, 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 [Adobe pdf, 4.8 mb]
This form is to be used when submitting clinical specimens to the CDC Bacterial
or Viral Labs.
Sample GI Illness Public Incidence Response Log
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 has proven
useful in some acute gastroenteritis outbreak investigations.