Provider Outbreak Report

Please complete our short online Provider Outbreak Report form to let us know if you have an infection outbreak, how many people are affected and the dates.

The information you submit will help ensure our Commissioning Team can support you in the best possible way.

Please note that this form does not replace the need to inform the UKHSA of any outbreaks.

1. Provider name*
2. Provider type*
4. Infection type
5. Total number of positive residents/service users
6. Total number of positive members of staff
7. Has anyone been admitted to the hospital?
  
  Yes
  
  No
8. Number of people who have been admitted to hospital
9. Date of initial case
10. Date of most recent case
12. Staff vacancies
13. Additional comments
15. Your name*
16. Your email address*
  We will email you a copy of the information you have entered once the form has been submitted
17. Your phone number
19. I confirm that the information I have submitted is, to the best of my knowledge, correct.*
  
  I agree