Required fields are marked with asterisks (*)

Child Care Setting Outbreak Reporting Form

This form is to be used by child care centre operators/supervisors to notify Durham Region Health Department if an outbreak of enteric illness is suspected or known to be occurring.

Please ensure you complete the child care centre outbreak line listing template. It is required to be uploaded prior to submitting this notification form.

Download our Child Care Centre Outbreak Line Listing template (xlsx)

If you require assistance downloading the above template or completing this form email us.

By using this form, you acknowledge and understand:

You are agreeing to be contacted.
Individual personal or personal health information should not be provided on this form.
While steps are taken to protect the privacy and security of submissions, sending and receiving submissions over the internet is not secure. We cannot guarantee the security of any submissions sent.
Do not use this submission form for emergency or urgent health care matters.

Facility information

Facility Name

Facility Address

City

Postal Code

Person notifying

First Name

Last Name

Phone Number

Email Address

Uploading your completed child care centre outbreak line listing:

To upload your child care centre outbreak line list you must browse to select your completed line list. Once you have completed the remainder of the form you must click the "Submit to Durham Region Health Department" button at the bottom of this page to send us your data. Please note that our reporting system is unable to process attachment(s) larger than 14MB. If the total size of all uploads is greater than 14MB, you will need to reduce the file size prior to uploading.

Please upload your completed file(s)

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Allowed extensions xls, xlsx

Personal and personal health information contained on this form is collected under the authority of the Health Protection and Promotion Act R.S.O. 1990, cH.7., s.5. This information is collected and used for the purposes of prevention and control of diseases through investigations, conducting risk assessments of suspected exposures and case management. Questions about this collection and use of information should be addressed to Durham Region Health Department, Manager, Health Information, Privacy and Security at 605 Rossland Rd E., P.O. Box 730, Whitby, ON L1N 0B2, (905) 668-7711.