Notifiable Disease Notification Forms
The preferred method for notification for notifiable diseases to Te Mana Ora | Community and Public Health is via Cortex or ERMS.
This page provides the notifiable disease forms that can be used by health professionals if Cortex or ERMS are unavailable.
Forms are also available to:
- report conditions related to hazardous substances; and
- report or summarise outbreaks affecting settings such as schools and early learning centres, rest homes or hospitals.
Any information provided is strictly confidential and subject to the Privacy Act.
Download the appropriate form below to send to your nearest Te Mana Ora | Community and Public Health Office.
Note: Most forms have now been consolidated across our coverage area.
Notification Forms
- Measles Notification Form [117KB] – updated December 2022.
- Pertussis Notification Form [171KB] – updated December 2022.
- Notifiable Diseases Notification Form for general practice [125KB] – updated December 2022.
- Notifiable Diseases Notification Form for hospitals [108KB] – updated December 2022.
- Hazardous Substances Disease and Injury Reporting Case Form [110KB] – updated December 2022.
- Find out how to notify STIs anonymously (on a Non-Identified Basis) through ESR. This includes AIDS and HIV, gonorrhoea and syphilis.
Outbreak Notification and Case Log Forms
Staff in care facilities need to act quickly if there is a sudden increase in diarrhoea, vomiting or respiratory symptoms. This includes hospitals and retirement villages.
Staff should take the following steps:
- Seek infection control advice from the local Infection Prevention and Control Service (such as IPCNursing[at]cdhb.health.nz).
- If this is a gastroenteritis outbreak, a Health Protection Officer will contact you to discuss laboratory testing and provide an outbreak number if testing of faecal or PCR specimens are required.
- Download the appropriate Outbreak Notification and Illness Log forms below. Email the completed forms to your local Community and Public Health office at the end of the outbreak.
- Report COVID positive test results on behalf of your residents via:
- RAT Catcher – this system is preferable as it will capture that the person is a resident in a facility; or
- My Health Record (formerly My COVID Record) – you can call 0800 222 478 and choose option 3). However this may result in calls from the Care in the Community teams asking if your residents need any clinical or manaaki support.
Email ratcatchersupport[at]health.govt.nz if you are interested in using RAT Catcher.
- Aged Residential Care Outbreak Notification Form [52KB] – updated September 2023. Formerly known as Rest Home Outbreak Notification Form.
- Disease Illness Log Form for Aged Residential Care [60KB] – updated September 2023. Formerly known as Outbreak Case Log Form.
- Hospital Outbreak Notification and Summary Form [44KB] – updated December 2022.
Staff in education settings should complete the following forms if they experience a gastroenteritis outbreak:
- Early Childhood Centre Outbreak Notification and Summary Form [54KB] – updated October 2023.
- School Outbreak Notification and Summary Form [54KB] – updated October 2023.
Contact the Protection staff at your local Te Mana Ora office for further information:
CANTERBURY
Ph: +64 3 364 1777
SOUTH CANTERBURY
Ph: +64 3 687 2600
WEST COAST
Ph: +64 3 768 1160
- Find out about Community and Public Health’s response to disease notifications.
- Find out about Community and Public Health’s response to gastroenteritis outbreaks in education settings.
Latest public health updates
- New national guidance on pertussis testing
- Identifying and managing suspected cyantoxin poisoning
- Information and resources on measles and MMR vaccination
Latest public health alerts
- Protecting infants against pertussis - 28th November 2024
- Pertussis (whooping cough) in Canterbury - 22nd May 2024
Featured links
- Prolonged Symptoms Attributable to Infection with COVID-19 (Ministry of Health)
- The Prevention of Legionellosis in New Zealand: Guidelines for the Control of Legionella Bacteria (Health NZ)
- Refugee Health Care: A Handbook for Health and Social Care Providers (Health NZ)