Run Influenza Outbreak Investigation Report - Long-Term Care — Free

Investigation Identification

Facility name and unit/wing affected critical (required)

Investigation start date and time critical (required)

Investigation lead and role critical (required)

Outbreak status critical (required)

Reference document or case log link

Enter the internal outbreak log, line list, or SOP reference used for this investigation.

Onset Timeline and Case Identification

First resident symptom onset date and time critical (required)

Note (optional)

First staff symptom onset date and time

Note (optional)

Total suspected resident cases critical (required)

Total confirmed resident cases critical (required)

Total suspected staff cases

Case line list completed and attached critical (required)

Yes No N/A

Resident Isolation, Cohorting, and PPE

Symptomatic residents isolated or placed on transmission-based precautions critical (required)

Yes No N/A

Cohorting plan implemented for affected residents critical (required)

Yes No N/A

PPE available at point of care for staff entering affected areas critical (required)

Yes No N/A

Staff observed using appropriate PPE for droplet precautions critical (required)

Yes No N/A

Hand hygiene supplies accessible at unit entrances and resident care areas critical (required)

Yes No N/A

Visitor restrictions or screening implemented for affected unit

Yes No N/A

Testing, Treatment, and Clinical Coordination

Influenza testing performed for representative cases critical (required)

Yes No N/A

Testing method used

Antiviral treatment or prophylaxis initiated per facility protocol critical (required)

Yes No N/A

Medical director or attending clinician notified critical (required)

Yes No N/A

High-risk residents identified and monitored

Yes No N/A

Reporting, Environmental Controls, and Closure

Local or state health authority notified critical (required)

Yes No N/A

Environmental cleaning and disinfection intensified in affected areas critical (required)

Yes No N/A

Staff and resident education provided on influenza symptoms and precautions

Yes No N/A

Corrective actions documented and assigned critical (required)

Yes No N/A

Closure criteria met critical (required)

Yes No N/A

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Run: Influenza Outbreak Investigation Report - Long-Term Care

Investigation Identification

Onset Timeline and Case Identification

Resident Isolation, Cohorting, and PPE

Testing, Treatment, and Clinical Coordination

Reporting, Environmental Controls, and Closure

Get your results