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CASES

Case Name

Comments

INTERVIEWS

Interview Date

First Name

Last Name

DOB

Address

Phone

Email

Comments

Got Sick
  • Food
  • Symptoms
  • Travels
  • Occupational
  • Zoonotics

Date

Time

Providers (Anyone in the supply chain of any item in this meal)

Food Consumed

Comments

Start Date

Start Time

End Date

End Time

Symptoms

Diagnosed Pathogen

Complete the form below if the interviewee has recently travelled to locations other than their usual workplace and localities
  • Travel Details
  • Accomodation Details
Date
Time
Vehicle No
Vehicle Type
From
To

Comments

From
To
Place
Room No

Comments

Date

Date

Workplace

Position

Tasks

Chemicals In Use

Comments

Vectors Exposed Exposed Got Sick Exposed Not Sick Not Exposed Not Exposed Got Sick Not Exposed Not Sick Relative Risk Odds Ratio
Name:
Symptoms:
Offset:
Duration:
Typical Food Vehicle:
Communicability:
Speciment Required:
Confirmation Criteria:
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