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Ebola Virus Disease (EVD) Case Report Form

(Last updated January 23, 2015)

Instructions for Completion

  • Please complete as much detail as possible on this form at the time of the initial report.
  • It is not expected that all fields will be completed during the initial report, but that updates will be made when information becomes available.

Instructions to local public health authorities

  • Reporting: Persons under investigation, and confirmed cases of EVD should be reported immediately as per jurisdictional protocols in the respective province or territory in Canada.

Instructions to provincial / territorial public health authorities

  • Reporting: Persons under investigation, and confirmed cases of EVD should be reported immediately to the Agency’s Health Portfolio Operations Centre (HPOC) at 1-800-545-7661.
  • Requests from provinces and territories for diagnostic or confirmatory laboratory services for EVD should be directed to the Public Health Agency of Canada's National Microbiology Laboratory at 1-866-262-8433.