Required fields are marked with asterisks (*)

Monthly Chickenpox Reporting Form

Reporting requirements

Chickenpox is a reportable disease to the Medical Officer of Health (Ontario Reg 135/18) under the Health Protection and Promotion Act. Schools and child care centres are required to report cases of chickenpox in both students and staff to Durham Region Health Department every month, even when there are no cases to report.

School or child care centre information

Contact first name

Contact last name

Phone number (999-999-9999)

Select your school board

Child care centre and under four-years old

Conseil scolaire catholique MonAvenir

Conseil scolaire Viamonde

Durham Catholic District School Board

Durham District School Board

Kawartha Pine Ridge District School Board

Peterborough, Victoria, Northumberland and Clarington Catholic District School Board

Private school

Are you reporting zero (0) cases for this month?

Yes

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Monthly Chickenpox Reporting Form

Reporting requirements

School or child care centre information