This form is no longer required. If you are a Long Term Care Facility (LTC) or Daycare / K-12 School please see the following instructions below.
Positive Residents or Staff
Report positive residents and employees employed at the Long Term Care Facility on the following form. (Please submit zero for both staff and resident case count when the facility has no new cases to report):
**This form must be completed every Tuesday by 11:59pm in order for the weekly cases to be reflected in the State of Ohio Long-term Care Facilities Dashboard. **
Daycare / K-12 Schools
Schools are required to submit COVID Clusters line lists only. The definition of a COVID Cluster has been defined in the Standardized COVID-19 K-12 School Surveillance Guidance for Classification of Clusters, 8/6/2021.
- A cluster would be a minimum of 3 cases OR 10% (†groups larger than 30)
- Cases occur within a core group
- Cases occur within 14 days prior to illness onset OR within 10 days after illness onset §
- A “core group” includes but is not limited to extracurricular activity†, cohort group, classroom, before/after school care, etc.)
† A school sanctioned extracurricular activity is defined as a voluntary activity sponsored by the school or local education agency (LEA) or an organization sanctioned by the LEA. Extracurricular activities include, but are not limited to, preparation for and involvement in public performances, contests, athletic competitions, demonstrations, displays, and club activities.
§ For onset, use symptom onset date whenever available. If symptom onset date is unknown or if a case is asymptomatic, use specimen collection date for the first specimen that tested positive. The 14-day period refers to 14 days before the date of first symptom onset or first positive test sample.
Based on the Ohio Department of Health: Contact Tracing and Case Investigation Statement, schools are expected to assist LHDs with contact tracing, case investigation and exposure notification related to clusters in schools as determined by the LHD.
Complete a line list of the positive cases involved in the cluster that includes the answers to the below questions. Email the completed list to: Communicabledisease@schd.org
Click on image below for Line List Excel Template
Submit any additional questions to: Communicabledisease@schd.org