Line List Template

A line list contains basic information about each person suspected to be part of a cluster or outbreak. Depending on the situation, both ill and well persons may be listed. This
template contains column variables that are commonly helpful in cluster or outbreak situations; however, column variables should added or removed based on the situation,
exposures, and disease. Often it is helpful to create a line list in an electronic format (such as Excel or Access) so it can be easily modified as additional information is received.

Situation Description: _______________________________________________________________________________________________________

_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
Investigator(s): ____________________________________________________________________________________________________________

Name or Initials or Sex Onset Symptom Specimen Collected or

Age County Occupation Symptoms* Dr Visit (Y/N) Exposure 1 Exposure 2 Exposure 3 Comments
Person ID# (M/F) Date/Time Duration Lab Tests

* Symptoms:
A = Abdominal Cramps
F = Fever (provide temperature)
R = Rash
Ch = Chills
M = Muscle Aches
V = Vomiting
H = Headache
Co = Cough
N = Nausea
O = Other (please list)
D = Diarrhea