Guidelines for the public health management of gastroenteritis outbreaks due to norovirus or suspected viral agents in Australia

Appendix 5.6: Line-list for recording case details in an outbreak of gastroenteritis in an aged-care facility

Page last updated: 2010

PDF printable version of Line-list for recording case details in an outbreak of gastroenteritis in an aged-care facility (PDF 37 KB)

[Please record details of all cases for monitoring progress of the outbreak and record keeping purposes.]

Facility name:

Facility Manager:

Telephone no.:

Email:

Total number of residents at facility:

Total number of staff at facility:

Case nameDate of
Birth
Sex
(M/F)
Staff (S) or resident (R)Date/time illness beganDate/time illness ceasedDiarrhoea (Y/N)Vomiting (Y/N)Hospitalised (Y/N)Died (Y/N)Faecal specimen collected (Y/N)Faecal specimen result