Acute Gastroenteritis/Norovirus Outbreak Reporting Form

Please complete this form if you are aware of a norovirus or acute gastroenteritis outbreak. An epidemiologist will be following up with you regarding the outbreak within one business day. If you have more immediate questions or concerns, please feel free to call us at 385-468-4194 during normal business hours. If you have questions or concerns after hours or on weekends or holidays, please call 801-580-8597.

Are you reporting an outbreak of two or more cases?

Please go to this website to report your individual illness.

Where did the outbreak happen?*
Please select which Homeless Resource Center:*
Phone
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Utah
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Common gastrointestinal illness symptoms include: diarrhea, nausea, vomiting, abdominal pain.

Please estimate how many students might be exposed to the outbreak. If this outbreak is contained to a classroom, enter the total number of students in the classroom.

Please estimate how many staff might be exposed to the outbreak. If this outbreak is contained to a classroom, enter the total number of staff in the classroom.

Please estimate how many children might be exposed to the outbreak. If this outbreak is contained to a classroom, enter the total number of children in the classroom.

Please estimate how many staff might be exposed to the outbreak. If this outbreak is contained to a classroom, enter the total number of staff in the classroom.

Is there a kitchen or food service in the childcare facility?

Please estimate how many staff might be exposed to the outbreak.

Please estimate how many patrons might be exposed to the outbreak.

Please estimate how many staff might be exposed to the outbreak.

Please estimate how many attendees might be exposed to the outbreak.

Please estimate how many residents might be exposed to the outbreak. If this outbreak is contained to a specific unit or building, enter the total number of residents in that unit or building.

Please estimate how many staff might be exposed to the outbreak. If this outbreak is contained to a specific unit or building, enter the total number of residents in that unit or building.

Please estimate how many guests might be exposed to the outbreak.

Please estimate how many staff might be exposed to the outbreak.

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