Illness complaint worksheet 2026

1. Click ‘Get Form’ to open the illness complaint worksheet in the editor.
2. Begin by entering the date and MAVEN ID# at the top of the form. This information is crucial for tracking your submission.
3. In the 'Person Completing Information' section, select your affiliation (Local BOH, State, or Other) and fill in your name, town or DPH division, and any other relevant details.
4. Next, complete the 'Reporter/Complainant' section by selecting your affiliation type and providing your contact information including name, phone number, and address.
5. Fill out the 'Illness Information' section by indicating how many people are ill, their symptoms, exposure details, and duration of illness. Be sure to mark any reported symptoms accurately.
6. In the 'Ill Persons' section, list each ill person's name, address, age, occupation, medical provider details, stool specimen status, and diagnosis if available.
7. Complete the 'Food History' section by documenting any suspect food or drink consumed within 72 hours prior to symptoms. Include dates and times for each entry.
8. Finally, review all entries for accuracy before submitting. Once completed, you can save or print your form directly from our platform.

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