Maritime Conveyance Illness or Death Investigation Form (OMB Control No.0920-0134 & 0920-0821)
When death or illness occurs while on cruise ships or other shipping vessels, this app should be completed to notify the Center for Disease Control (CDC) about the disease or death.
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The Maritime Conveyance Illness or Death Investigation Form app should not be used for influenza-like illness, but rather other health or infectious disease concerns. Users will be required to complete information about the vessel such as ports visited, as well as the medical history of the ill or deceased individual. A list of symptoms, a roster of who the ill has had face-to-face contact with (including ship workers), what medical treatment had been administered, which medical tests have been completed, and signs of infectious diseases will be recorded. The health officer will be asked to determine a presumptive diagnosis or cause of death. This information will be shared with the quarantine station to assure there is not a greater public health risk beyond the vessel.
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