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Surveillance Forms

For Health Care Professional use only

Enhanced Surveillance Form for Confirmed Hospitalised Influenza cases aged 0-14 years 

Surveillance form for outbreaks/clusters of Influenza-like illness and Influenza  

Adult Influenza ICU Admission Form 

Adult Influenza ICU Discharge Form 

Paediatric Influenza ICU Admission Form 

Paediatric Influenza ICU Discharge Form 



Health Protection Surveillance Centre, 25-27 Middle Gardiner St, Dublin 1, Ireland. t: +353 1 8765300 f: +353 1 8561299 e:hpsc@hse.ie
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