GCHD-Weekly School and Daycare Communicable Disease Report

School and Daycare Communicable Disease Report
This form is now serving as the PRIMARY form for collecting communicable disease data. Thank you for submitting the weekly communicable disease report for your school or daycare. Your continued effort in reporting communicable diseases in schools and daycares is very important to the health of Genesee County.

If you have not received a password, please reach out to Mikayla at GCHD.

Email: mbenbow@geneseecountymi.gov

or

Phone: 810-257-3869
Please enter the keyword to access the form.*
District and School/Daycare*
If you do not see your school/daycare listed above, please click here for further instructions.

School/Daycare Contact Information
Weekly Illness Report
YesNo
Week Ending:

MonthDayYear
Date
Current School Enrollment Number:
No new diseases to report this week.
Total Number of Children Absent this Week:*
Number of Flu-Like illnesses:*
Number of stomach viruses: *
Number of Strep Throat Illnesses:*
Number of confirmed influenza, including H1N1:*
Number of COVID-19 Cases:*
YesNo
Individual Illness Report

Please report any individuals with these illnesses: Measles, Mumps, Rubella, Pertussis (whooping cough), Haemophilus influenza Type B (HiB), Meningitis (bacterial and viral), Encephalitis, Hepatitis, Tuberculosis, or Chickenpox.
YesNo
Submitted By:*

Submitter First NameSubmitter Last Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Additional Comments
Today's Date

MonthDayYear
Date
Hour MinutesAM/PM Option
Should be Empty:

School and Daycare Communicable Disease Report

Weekly Illness Report

Individual Illness Report