McHenry County Department of Health - School Nurse Website
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Weekly Report of Illnesses and Symptoms

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Please correct the field(s) marked in red below:

School District/Name:
 *
No. of Students Enrolled:
 *
Week Ending:
 *
Reported By:
 *

20 ILCS 2305 authorizes rules that require reporting of communicable diseases; 77 Ill. Adm. Code 690.350 mandates reporting by mail, telephone, or fax as soon as possible, but within seven days.

PLEASE HAVE WEEKLY REPORTS SUBMITTED BY 3:00 PM FRIDAY.

If you notice an unusual increase of a specific symptom or illness, please notify MCDH immediately at 815-334-4500.


ABSENCES DUE TO GASTROINTESTINAL ILLNESS
Absences due to one or more of the following symptoms: NAUSEA, VOMITING, DIARRHEA

If there were no reported symptoms on a given day, type "0"
If school was not in session on a given day, type "no session"

GI Absences: Monday
 *
GI Absences: Tuesday
 *
GI Absences: Wednesday
 *
GI Absences: Thursday
 *
GI Absences: Friday
 *
Brief GI Description (If Necessary):

ABSENCES DUE TO INFLUENZA LIKE ILLNESS (ILI)
Absences due to ILI. ILI is defined as fever (a temperature of 100⁰ F [37.8⁰ C] or higher orally) AND new onset of cough and/or sore throat. Please count as an absence any case where you are unsure of the temperature of the fever or if the onset of cough and/or sore throat is new.

If there were no reported symptoms on a given day, type "0"
If school was not in session on a given day, type "no session"

ILI Absences: Monday
 *
ILI Absences: Tuesday
 *
ILI Absences: Wednesday
 *
ILI Absences: Thursday
 *
ILI Absences: Friday
 *
Brief ILI Description (If Necessary):

TOTAL DAILY ABSENT STUDENTS (Include ALL Absent Students)

If there were no reported absences on a given day, type "0"
If school was not in session on a given day, type "no session"

Absences: Monday
 *
Absences: Tuesday
 *
Absences: Wednesday
 *
Absences: Thursday
 *
Absences: Friday
 *

Additional Comments:
Please maintain consistent symptom reporting. If students have both GI and ILI, mark both fields.
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