Outbreak Reporting Form

  • Current Introduction
  • Start Reporting
  • Case Information
  • Additional Details
  • Sign-off
  • Immediate Control Measures
  • Review
If you are making a report after 4 p.m., please contact our after-hours support at (905) 953-6478. This form is not monitored after 4 p.m. or on weekends and holidays.

This form is meant for administrators or operators at high-risk settings including institutional and congregate settings (Long Term Care Home, Retirement Home, Group Homes, Shelters, childcare centres, day camps and other congregate care settings) to report new cases and outbreaks.

Anything with a red asterisk (*) is mandatory.

Please indicate the type of outbreak you are reporting:
Please Note: This information is being collected under the authority of the Health Protection and Promotion Act, R.S.S. 1990, C.H.7 for the purpose of case management and case investigations, client follow up and monitoring, contract tracing, public health administration and the provision of statistical data to the Ministry of Health and Long-Term Care.  Information will be retained, used, disclosed and disposed of in accordance with the Personal Health Information and Protection Act, 2004, S. O. 2004, c. 3. Any questions regarding this collection may be directed to the Program Manager, Information Management Access and Privacy, Community and Health Services Department, 17150 Yonge Street, 6th Floor, Newmarket, Ontario, L3Y 8T5, Telephone 1-877-464-9675 ext. 73003, Fax 905-895-3149, Email chsprivacy@york.ca.