Forms for Health Professionals

Communicable Disease (Including Food Poisoning, Animal Bite Exposure and STIs)

• Communicable Disease, including STIs and Food Poisoning Reporting Form (all diseases, excluding COVID-19)

Specific Diseases

• COVID-19 Reporting Form
• Report an Animal Bite Exposure
• Chickenpox (Varicella) Reporting Form
• Hepatitis B Hospital Neonate Reporting Form
• Report an Infection From a Tattoo, Piercing, Manicure or Pedicure
• STI Medication Order Form
• Tuberculosis
  • Notification of Latent TB Infection and Medication Order Form
  • Notification of Active TB Disease Reporting Form

More Information

• Reporting Tuberculosis
• Reporting an Enteric or Respiratory Outbreak at an Institution
• More Information on Report an Animal Bite Exposure

Immunization and Vaccines

Publicly Funded Vaccines and Supplies

• Requisition for Biological Supplies (OGPMSS)

Vaccines for High-Risk Groups

Note: Please read the eligibility criteria before ordering online.

Reporting Forms

• Reporting a Cold Chain Incident and related forms
• Power Outage and Vaccine Storage
• Returning Expired or Spoiled Vaccines
• Vaccine cold chain maintenance and inspection report
• AEFI Reporting Form (Public Health Ontario). Fax the completed form to 416-338-2028. Note: If the form doesn’t open from the link above, download it using the download icon on the top right of the page. Use Adobe’s free Acrobat Reader software to complete and save the fillable form.

Preschool Speech and Language Program

Preschool Speech and Language Program

• Paediatric Speech and Language Screening Tool

Financial Reporting

• Budget Template
• Settlement Certification and Auditor’s Statement Template

Program Delivery and Reporting

• Geographic Service Areas
• PSL Data Tracking Manual
• Early Abilities Client Tracking Form
• PSL Outcome Measurement Guide
• Outcome Measures Record Form

Blind-Low Vision Early Intervention Program

Referral

• Vision/Eye Report Form 
• Blind-Low Vision Referral Form

Financial Reporting

• Budget Template
• Settlement Certification and Auditor’s Statement Template

Program Delivery and Reporting

• Client Tracking Form
• Service Targets 2021-22

Infant Hearing Program

Referral

• Infant Hearing Program (IHP) Intake Form

Audiology

Financial Reporting

• Audiology Monthly Invoice Summary
• Audiology Cost Tracking Form
• Appointment Types/Fee Schedule/Invoicing Requirements

Program Delivery Reporting

• Goals and Deliverables
• Equipment Repair Protocol
• Audiology Form – Ax/CI/HR Surveillance

Communication Development

Financial Reporting

• Communication Invoicing and Client Tracking Form 2021-22

Program Delivery Reporting

• Standardized Test Results Outcome Measures Form
• Coordinated Family Services Plan 

Screening

Financial Reporting

• Screening Invoice Monthly Summary and Fee Schedule

Program Delivery and Reporting

• Equipment Repair Protocol
• Screening Cost and Tracking Form
• Infant Hearing Program (IHP) Screening Documentation Instruction

Outbreak Management for Institutions

Long-Term Care and Retirement Homes

Respiratory

• Initial Respiratory Outbreak Notification Form
• Respiratory Outbreak – Non-COVID Line List and Epicurve**
• COVID-19 LRCT Line List & Epicurve**
• Full Resident and Staff Identification List**
• Respiratory Hospitalizations and Deaths Line List Form
• Outbreak Transfer Notification
• Respiratory Outbreak Management Team Meeting Checklist
• COVID-19 and Respiratory Virus Test Requisition Form (PHO)

**While we aim to provide fully accessible content, there is no text alternative available for some of the content on this site. If you require alternate formats or need assistance understanding our maps, drawings, or any other content, please contact us at LRCT@toronto.ca

Specimen Collection

• How to Collect a Nasopharyngeal Swab
• Respiratory Outbreak Test Requisition Form Sample

Enteric

• Initial Enteric Outbreak Notification Form
• Enteric Outbreak Line List** 
• Enteric Hospitalizations and Deaths Line List Form 
• Outbreak Transfer Notification
• Enteric Outbreak Management Team Meeting Checklist

**While we aim to provide fully accessible content, there is no text alternative available for some of the content on this site. If you require alternate formats or need assistance understanding our maps, drawings, or any other content, please contact us at 416-338-8782 or LRCT@toronto.ca

Acute Care and Complex Continuing Care Facilities

Respiratory

• Initial Respiratory Outbreak Form 
• Outbreak Notification Sign 
• Instructions for Collecting a Nasopharyngeal Swab 
• Respiratory Outbreak Summary and Epi-Curve 
• Community Care Access Centre (CCAC) Outbreak Notification Form 
• Respiratory Outbreak Transfer Notification Form 
• Respiratory Outbreak Management Team Meeting Checklist

Enteric

• Public Health Laboratory – Outbreak Notification Report Form
• Initial Enteric Outbreak Notification Form
• Enteric Outbreak Line List
• Enteric Hospitalizations and Deaths Line List form
• Outbreak Notification Sign
• Enteric Outbreak Transfer Notification Form

C-difficile

• Clostridium Difficile Outbreak Line List
• Clostridium Difficile Outbreak Epi Curve
• Clostridium Difficile Outbreak Checklist

More Information

More Information on Enteric and Respiratory Outbreaks

Laboratory

• Public Health Laboratories requisitions and specimen collection guide, OAHPP