Animal Bite / Rabies Investigation Form 

Communicable Disease Passenger Declaration Form

Communicable Disease Report Form

Food and Waterborne Illness Investigation Form

Passive Surveillance for Blacklegged ticks (Public Health Agency of Canada)

Infectious Diseases

• Respiratory Virus Severe Outcomes Surveillance Report Form (NEW - November 2022)
• NWT Measles Case Investigation Form
• Meningitis Investigation Form
• MRSA Investigation Form
• NWT RSV Prophylaxis Risk Assessment and Order Form
• Pertussis Investigation Form (January 2020)
• Pertussis Contact List (January 2020)
  • Pertussis Contact List (PDF)
  • Pertussis Contact List (Excel)
• Preliminary Monkeypox Case Report Form (PHAC) 
  • Monkeypox Contact List (Excel) (September 2022)

Immunizations

• Vaccination Administration Report Form (Only for those not on EMR)(NEW - January 2023)

Sexually Transmitted Infections

• Hepatitis B and C Case Investigation Form
• NWT STI Case Investigation Report Form (UPDATED - November 2022)
• NWT STI Contact Tracing Form (UPDATED - November 2022)
• NWT Biolytical Inti HIV/Syphilis Multiplex Point-of-Care Test (POCT) Reporting Form (September 2022)
• Syphilis & HIV Lost-to-Follow-up Report Form 

Tuberculosis

• NWT Bacille Calmette-Guérin (BCG) Vaccine Consent Form 
• NWT BCG Vaccine Reporting Form 
• TB Assessment Form
• Active TB Drug Treatment and Progress Record
• Latent Tuberculosis Infection (LTBI) Treatment Initiation Form
• Latent Tuberculosis Infection (LTBI) Treatment Completion Form
• Latent Tuberculosis Infection (LTBI) Drug Treatment & Progress Record
• LTBI Tuberculosis Surveillance
• Tuberculosis Case and Contact Tracing Record
• Tuberculosis Surveillance & Screening