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Run: Respiratory Illness Outbreak Line List

Track resident and staff respiratory illness cases in one outbreak line list with onset dates, testing, isolation, work restrictions, and control actions. Us...

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Inspection Details

Facility name recorded critical (required)

Inspection date and time recorded critical (required)

Outbreak review period defined critical (required)

Enter the date range covered by the line list, such as the current outbreak period or surveillance window.

Reviewer name and role recorded critical (required)

Case Line List Completeness

Unique case identifier assigned critical (required)

Case type identified as resident or staff critical (required)

Symptom onset date recorded critical (required)

Primary respiratory symptoms documented critical (required)

Case status updated critical (required)

New cases added for the current day critical (required)

Line list updated for all known cases critical (required)

Yes No N/A

Exposure, Testing, and Clinical Status

Known exposure source documented

Testing status recorded critical (required)

Specimen collection date recorded when tested

Hospitalization or ED transfer status recorded

Outcome or current condition documented

Isolation, Cohorting, and Work Restrictions

Resident isolation or cohorting status documented critical (required)

Staff work restriction or exclusion status documented critical (required)

PPE use aligned to respiratory precautions critical (required)

Yes No N/A

Symptomatic resident transfer or appointment precautions documented

Yes No N/A

Isolation start date recorded

Outbreak Control Actions and Reporting

Public health notification completed when required critical (required)

Yes No N/A

Physician, resident representative, or responsible party notified as applicable

Yes No N/A

Corrective actions documented for gaps in surveillance or infection control critical (required)

Yes No N/A

Reference document used for outbreak tracking

Inspector signature critical (required)

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