| FORMAT FOR OUTBREAK INVESTIGATION REPORT
General Information
State:
_____________________________________________________
District: _____________________________________________________
Town/PHC:
_________________________________________________
Ward/Village:
_______________________________________________
Population:
_________________________________________________
Background Information
Person reporting the outbreak: ______________________________
Date of report: ____________________________________________
Date investigations started: __________________________________
Person(s) investigating the outbreak: ______________________________
Details of Investigation
Describe how the cases were found may include: (a) house-to-house search in the affected area; (b) visiting block areas adjacent to the affected households; (c) conducting record reviews of local hospitals; (d) requesting health workers to report similar cases in their areas, etc.):
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Descriptive Epidemiology
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Cases by time, place and person (attach summary tables and relevant graphs and maps).
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