MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES
MICHIGAN SCHOOL BUILDING WEEKLY REPORT OF COMMUNICABLE DISEASE TO LOCAL HEALTH DEPARTMENT
According to Public Act 368, of 1978 as amended, the local health department shall be notified immediately of the occurrence of communicable disease (especially rash-like illnesses with fever).
In addition to immediate notification by telephone, please include all occurrences on this form and fax or mail to your local health department.
A: Record appropriate information in Sections 1, 2, 3, 4 & 5.
B: Submit this form EACH FRIDAY to the Tuscola County Health Department EVEN IF THERE ARE NO DISEASES TO REPORT.
C. Add additional sheets as necessary.
3 Indicate here (by number only) suspected or confirmed cases of:
Pediculosis (Head Lice):
Gastrointestinal Illness (diarrhea and/or vomiting for 24-48 hours):
*Count as APPARENT FLU case any child with pneumonia or fever and any of the following symptoms: sore throat, cough, generalized aching in the back or limb muscles. Please report apparent influenza by total numbers only. Vomiting and diarrhea alone are not indications of influenza.
4 Place an X here if:
NO DISEASES TO REPORT
SCHOOL CLOSED DUE TO DISEASE