Line Listing for Respiratory Illness Outbreaks

Line Listing for Respiratory Illness Outbreaks List for: Residents/patients____ Employees____ (check one) Unit+:______

Name of Facility:______Address:______Contact Person:______Telephone:______

Signs and symptoms Laboratory results

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Use a separate line list for residents on each unit, if possible.

*List shift and unit (or ward) for employee cases