Communicable Disease
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