Emerging Respiratory Pathogens and Severe Acute Respiratory Infection(SARI) Case Report Form

Version 0.8 (Last updated June 19, 2015)

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: Please report cases using normal local / provincial/territorial methods
• Travel: The Office of Quarantine Services at the Public Health Agency of Canada may be of assistance with requesting passenger manifests from conveyance operators, when requested to do so, by a local public health authority. Local public health authorities can contact the manager on-call 1-416-MANAGER (626-2437).

Instructions to provincial / territorial public health authorities

• Reporting: Fax completed form (without first page) to 1-800-332-5584 and send an email notification (do not attach form) to HSFLUEPI@phac-aspc.gc.ca, within 24 hours of case notification to Provincial/Territorial Public Health.
• After regular business hours (8:00 – 5:00pm ET) please contact the Agency Medical Officer on-call at 613-952-7940