OMB Approved Control
No. XXXX-XXX Exp.
XX/XX/XXXX
**Please submit to eocevent349@cdc.gov daily by 0900 ET**
Directions: Please enter all data for;
1) Case counts and traveler test results identified for the previous day
(i.e., report submitted by 0900 ET today will include information from yesterday [0000 hrs. to 2359 hrs. ET]), and
2) Traveler test results received since last submission (previously entered as “pending”) for the following:
Symptomatic Case Counts with Viral testing
Asymptomatic Case Counts with Viral testing for
Identified close contacts
Embarkation day screening
Quarantine day 14 screening of newly embarking crew
Routine screening
Disembarkation day screening
Completion of this form is required by cruise ships operating or intending to operate in U.S. waters during the period of CDC’s Framework for Conditional Sailing Order (CSO). For additional guidance, see Technical Instructions for Mitigation of COVID-19 Among Cruise Ship Crew.
Ship: |
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Date Submitted (mm/dd/yy): |
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Closest seaport at time of submission (City and Country): |
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GPS coordinates of ship at time of submission (in decimal degrees): |
Total # of travelers onboard: |
Crew |
Passengers |
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Latitude: |
Longitude: |
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Important Reminders About COVID-19 and Influenza Testing for COVID-19 via Nucleic Acid Amplification Test (NAAT)
Identifying Vaccine Adverse Events for COVID-19 and Influenza
Please report any vaccine adverse events (i.e., side effects or allergic reactions) to CDC’s Vaccine Adverse Event Reporting System (VAERS). Influenza Management
Reporting Cruise Ship Fatalities or Other Illnesses of Public Health Concern
Check to acknowledge that you have reviewed these Important Reminders ☐
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Today, are you reporting traveler test results that were previously entered as “pending” for the following (check all that apply)?
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Symptomatic Case Counts with Viral Testing: |
Enter Numbers Below (Unless Otherwise Specified) |
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Crew |
Passengers |
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What is your COVID-19-like Illness (CLI) case count for the previous day? CLI clinical criteria:
or
or
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1 |
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2 |
Of those CLI cases, how many were tested for COVID-19 via a nucleic acid amplification test (NAAT), such as:
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3 |
Of those CLI cases tested for COVID-19 via a NAAT, how many tested positive? |
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4 |
Of those CLI cases that tested positive for COVID-19 via a NAAT, how many were newly embarking crew members in quarantine? |
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5 |
Of those CLI cases tested for COVID-19 via a NAAT, how many tested negative? |
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6 |
Of those CLI cases that tested negative for COVID-19 via a NAAT, how many tested positive for influenza? |
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7 |
Of those CLI cases that tested negative for COVID-19 via a NAAT, how many tested positive for another respiratory pathogen (e.g., RSV or Legionella)? |
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8 |
Of those CLI cases tested for COVID-19 via a NAAT, how many never registered a positive or negative result (e.g., inconclusive or invalid result)? |
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9 |
Of those CLI cases tested for COVID-19 via a NAAT, how many results are pending? |
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10 |
If pending, please choose why (please circle all that apply): a) onboard testing capability for this ship is pending b) ran out of supplies (e.g., cartridges) c) technical/mechanical problems |
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11 |
Of those CLI cases tested for COVID-19 via a NAAT with pending results on a previous EDC submission day, how many tested positive? |
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12 |
Of those CLI cases that tested positive for COVID-19 via a NAAT from pending results on a previous EDC submission day, how many were newly embarking crew members in quarantine? |
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13 |
Of those CLI cases tested for COVID-19 via a NAAT with pending results on a previous EDC submission day, how many tested negative? |
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14 |
Of those CLI cases tested for COVID-19 via a NAAT with pending results on a previous EDC submission day, how many never registered a positive or negative result (e.g., inconclusive or invalid result)? |
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15 |
Of those persons symptomatic with CLI for this reporting day, how many were not tested for COVID-19 because they had already tested positive as an identified close contact (and asymptomatic) in the past 14 days (i.e., on a previous reporting day)? |
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16 |
Were there any additional symptomatic cases that were not accounted for by the questions above? Please explain: |
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HOSPITALIZATIONS |
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17 |
How many symptomatic persons needed hospitalization (onboard or ashore) due to CLI or COVID-19? |
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18 |
Of those hospitalized due to CLI or COVID-19, how many required mechanical ventilation? |
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19 |
Of those hospitalized due to CLI or COVID-19, how many were medically evacuated from the ship? |
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Asymptomatic Case Counts with Viral Testing: |
Enter Numbers Below (Unless Otherwise Specified) |
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Crew |
Passengers |
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20 |
How many asymptomatic persons were tested for COVID-19 via a NAAT after being identified as a close contact of a:
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21 |
Of the asymptomatic persons tested for COVID-19 via a NAAT after being identified as a close contact, how many tested positive? |
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22 |
Of the asymptomatic persons tested for COVID-19 via a NAAT after being identified as a close contact, how many tested negative? |
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23 |
Of the asymptomatic persons tested for COVID-19 via a NAAT after being identified as a close contact, how many were never able to register a positive or negative result (e.g., inconclusive or invalid result)? |
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24 |
Of the asymptomatic persons tested for COVID-19 via a NAAT after being identified as a close contact, how many results are pending? |
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25 |
If pending, please choose why (please circle all that apply): a) onboard testing capability for this ship is pending b) ran out of supplies (e.g., cartridges) c) technical/mechanical problems |
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26 |
Of the asymptomatic persons tested for COVID-19 via a NAAT after being identified as a close contact with pending results on a previous EDC submission day, how many tested positive? |
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27 |
Of the asymptomatic persons tested for COVID-19 via a NAAT after being identified as a close contact with pending results on a previous EDC submission day, how many tested negative? |
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28 |
Of the asymptomatic persons tested for COVID-19 via a NAAT after being identified as a close contact with pending results on a previous EDC submission day, how many were never able to register a positive or negative result (e.g., inconclusive or invalid result)? |
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EMBARKATION DAY TESTING |
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29 |
How many asymptomatic persons were tested for COVID-19 via a NAAT on the day of embarkation? |
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30 |
Of the asymptomatic persons tested for COVID-19 via a NAAT on the day of embarkation, how many tested positive? |
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31 |
Of the asymptomatic persons tested for COVID-19 via a NAAT on the day of embarkation who tested positive, how many cases were persistent positives (i.e., viral debris/dead bugs)? Note: CDC cannot make a persistent positive determination without submission of a previously positive NAAT result within the specified time period. |
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32 |
Were the previously positive NAAT results sent to CDC Maritime Unit: eocevent349@cdc.gov? (please circle one) Yes/No |
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33 |
Of the asymptomatic persons tested for COVID-19 via a NAAT on the day of embarkation, how many tested negative? |
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34 |
Of the asymptomatic persons tested for COVID-19 via a NAAT on the day of embarkation, how many were never able to register a positive or negative result (e.g., inconclusive or invalid result)? |
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35 |
Of the asymptomatic persons tested for COVID-19 via a NAAT on the day of embarkation, how many have pending results (Note: this applies to crew only)? |
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36 |
Of the asymptomatic crew members tested for COVID-19 via a NAAT on the day of embarkation with pending results on a previous EDC submission day, how many tested positive? |
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37 |
Of the asymptomatic crew members tested for COVID-19 via a NAAT on the day of embarkation with pending results on a previous EDC submission day, how many tested negative? |
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38 |
Of the asymptomatic crew members tested for COVID-19 via a NAAT on the day of embarkation with pending results on a previous EDC submission day, how many were never able to register a positive or negative result (e.g., inconclusive or invalid result)? |
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QUARANTINE DAY #14 TESTING OF NEWLY EMBARKING CREW |
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39 |
How many asymptomatic newly embarking crew members were tested for COVID-19 via a NAAT on day #14 of quarantine (i.e., prior to leaving quarantine)? |
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40 |
Of the asymptomatic newly embarking crew members tested for COVID-19 via a NAAT on day #14 of quarantine, how many tested positive? |
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41 |
Of the asymptomatic newly embarking crew members tested for COVID-19 via a NAAT on day #14 of quarantine, how many tested negative? |
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42 |
Of the asymptomatic newly embarking crew members tested for COVID-19 via a NAAT on day #14 of quarantine, how many were never able to register a positive or negative result (e.g., inconclusive or invalid result)? |
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43 |
Of the asymptomatic newly embarking crew members tested for COVID-19 via a NAAT on day #14 of quarantine, how many have pending results? |
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44 |
Of the asymptomatic newly embarking crew members tested for COVID-19 via a NAAT on day #14 of quarantine with pending results on a previous EDC submission day, how many tested positive? |
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45 |
Of the asymptomatic newly embarking crew members tested for COVID-19 via a NAAT on day #14 of quarantine with pending results on a previous EDC submission day, how many tested negative? |
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46 |
Of the asymptomatic newly embarking crew members tested for COVID-19 via a NAAT on day #14 of quarantine with pending results on a previous EDC submission day, how many were never able to register a positive or negative result (e.g., inconclusive or invalid result)? |
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ROUTINE TESTING |
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47 |
How many asymptomatic persons were tested for COVID-19 via a NAAT for routine crew screening or passenger voyage testing? |
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48 |
Of the asymptomatic persons tested for COVID-19 via a NAAT for routine crew screening or passenger voyage testing, how many tested positive? |
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49 |
Of the asymptomatic persons tested for COVID-19 via a NAAT for routine crew screening or passenger voyage testing, how many tested negative? |
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50 |
Of the asymptomatic persons tested for COVID-19 via a NAAT for routine crew screening or passenger voyage testing, how many were never able to register a positive or negative result (e.g., inconclusive or invalid result)? |
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51 |
Of the asymptomatic persons tested for COVID-19 via a NAAT for routine crew screening, how many have pending results (Note: this applies to crew only)? |
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52 |
Of the asymptomatic persons tested for COVID-19 via a NAAT for routine crew screening with pending results on a previous EDC submission day, how many tested positive? |
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53 |
Of the asymptomatic persons tested for COVID-19 via a NAAT for routine crew screening with pending results on a previous EDC submission day, how many tested negative? |
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54 |
Of the asymptomatic persons tested for COVID-19 via a NAAT for routine crew screening with pending results on a previous EDC submission day, how many were never able to register a positive or negative result (e.g., inconclusive or invalid result)? |
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DISEMBARKATION DAY TESTING |
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55 |
How many asymptomatic persons were tested for COVID-19 via a NAAT on the day of disembarkation? |
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56 |
Of the asymptomatic persons tested for COVID-19 via a NAAT on the day of disembarkation, how many tested positive? |
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57 |
Of the asymptomatic persons tested for COVID-19 via a NAAT on the day of disembarkation, how many tested negative? |
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58 |
Of the asymptomatic persons tested for COVID-19 via a NAAT on the day of disembarkation, how many were never able to register a positive or negative result (e.g., inconclusive or invalid result)? |
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59 |
Of the asymptomatic persons tested for COVID-19 via a NAAT on the day of disembarkation, how many have pending results (Note: this applies to crew only)? |
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60 |
Of the asymptomatic crew members tested for COVID-19 via a NAAT on the day of disembarkation with pending results on a previous EDC submission day, how many tested positive? |
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61 |
Of the asymptomatic crew members tested for COVID-19 via a NAAT on the day of disembarkation with pending results on a previous EDC submission day, how many tested negative? |
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62 |
Of the asymptomatic crew members tested for COVID-19 via a NAAT on the day of disembarkation with pending results on a previous EDC submission day, how many were never able to register a positive or negative result (e.g., inconclusive or invalid result)? |
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63 |
Were there any additional asymptomatic cases that were not accounted for by the questions above? Please explain: |
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Isolation Practices: Were the following persons isolated for COVID-19 per CDC guidelines:
Note: Isolation may be discontinued for symptomatic persons with CLI or confirmed COVID-19 under conditions outlined at: www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html |
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Public reporting burden of this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB Control Number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA 0920-0900.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Maritime Unit |
File Modified | 0000-00-00 |
File Created | 2021-05-31 |