Required fields are marked with asterisks (*)

CHICKENPOX (Varicella) - Daily Reporting Form

Please complete a separate form to report a NEW case of chickenpox (varicella) in a Childcare setting or School.

For information about chickenpox (varicella), please see our webpage.

Please contact the Communicable Disease Control Program for any questions or concerns.

Tel: 705-474-1400 or toll free at 1-800-563-2808, ext. 5229, or email us at cdc@healthunit.ca

What is the reporting date?

What is the name and telephone number of the Childcare setting or School?

What is the name of the child? Please enter the first and last name.

What is the age of the child?

What is the child's home address?

Please enter your name as the submitter of this information and you acknowledge that the information is true and accurate.

“This information is being collected pursuant to the Health Protection and Promotion Act, R.S.O. 1990, c.H.7 and will be retained, used, disclosed, and disposed of in accordance with the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990, c.M.56, the Personal Health Information Protection Act, 2004, S.O.c.3 and all applicable federal and provincial legislation and regulations governing the collection, retention, use, disclosure, and disposal of information. Any questions regarding this collection may be directed to the Personal Health Information Lead at the North Bay Parry Sound District Health Unit, 345 Oak Street West, North Bay, ON P1B 2T2, 705-474-1400 / 1-800-563- 2808 or at privacy@healthunit.ca.”

Last updated: July 2024

Form Builder

CHICKENPOX (Varicella) - Daily Reporting Form