School and Child Care Center Outbreak Report

Schools and child care centers play an essential role in surveillance of communicable disease among children. Please use this secure form to report a cluster/outbreak of a reportable communicable disease. After submitting this survey, Washtenaw County Health Department will contact you if we require additional information.

1. Today's date *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

2. Submitter's name (first and last) *This question is required.

3. Submitter's email *This question is required. This question requires a valid email address.

4. Submitter's phone number

5. Please select the school building/center affiliated with the cluster/outbreak *This question is required.If you do not see your school building/center listed, please select the Other Facility Not Listed option. Include the name of the school building/center in the last question of the survey and we will add it to the list. You can also email milgromt@washtenaw.org to be added.

Location Type/Affiliation
Location