Ebola disease case report form

Download the Ebola disease case report form (PDF, 851 KB, 6 pages)

How to download and open the PDF

• Instructions for PC users

  1. Right-click the link of the PDF form you wish to download.
  2. Select Save link as or Save target as.
  3. Choose the location on your computer where you want to save the PDF form.
  4. Go to the file location where you saved the PDF form.
  5. Open the PDF form with a PDF reader (such as Adobe Reader).
  6. Fill and save your PDF form.

• Instructions for Mac users

  1. Press the Control key (Ctrl) and click on the link of the form you wish to download.
  2. Choose Save link as or Download linked file as.
  3. Choose the location on your computer where you want to save the PDF form.
  4. Go to the file location where you saved the PDF form.
  5. Open the PDF form with a PDF reader (such as Adobe Reader).
  6. Fill and save your PDF form.

Instructions for completion

• Please complete as much detail as possible on this form at the time of the initial report.
• It is not expected that all fields will be completed during the initial report, but that updates will be made when information becomes available.

Instructions to local public health authorities

• Reporting: Persons under investigation, and confirmed cases of Ebola disease should be reported immediately as per jurisdictional protocols in the respective province or territory in Canada.

Instructions to provincial / territorial public health authorities

• Reporting: Persons under investigation, and confirmed cases of Ebola disease should be reported immediately to the Agency's Health Portfolio Operations Centre (HPOC) at 1-800-545-7661.
• Requests from provinces and territories for diagnostic or confirmatory laboratory services for Ebola disease should be directed to the Public Health Agency of Canada's National Microbiology Laboratory at 1-866-262-8433.