COVID LTC Weekly Case Reporting
Summit County Public Health
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Long Term Care Facility *
Week Reporting ***ONE SUBMISSION PER WEEK*** (each week’s report should capture data from Wednesday of the week before through the current Tuesday) *
Current Resident Case Count *
NEW positive cases that were tested during the reporting week.
Current Staff Case Count *
NEW positive cases that were tested during the reporting week.
Please list all positive case information (Line List) in the space provided below: *
Medical Name, Date of Birth | Medical Name, Date of Birth
LTC Contact Name *
LTC Contact Phone Number *
LTC Email *
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