School Outbreak Reporting Form

School & Daycare Outbreak Reporting Form

Please use this form to report any suspected or confirmed outbreak of a communicable disease at your school to the Kent County Health Department (KCHD). Our team will review the information and follow up with you as needed. Thank you for helping us protect the health of our community!

1. Please provide us with the following information:

Your Name
Phone Number
Email Address
School/Daycare Name

2. What is the known or suspected condition you are reporting?

3. If "Other", please describe:

4. What illness have they been diagnosed with?

4. What is the onset date of the first case? (mm/dd/yyyy)

5. Total number of symptomatic persons (include those with or without confirmed diagnosis):

# of students/attendees
# of staff

6. Are there cases located in a specific building, unit, or class? If yes, please provide additional details: