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OPRP - Forms

    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.