Department of Medicine

RTI Surveillance Forms and Instructions

How are forms submitted?

All forms can be faxed to the following number: (404) 712-1029, or sent as a PDF to the coordinator's email.

Denominator forms

  • A denominator form should be turned in EACH MONTH, regardless of whether or not there are any RTI infections.
  • These will be due the 1st Friday following the end of the month

Prospective event forms

  • If there are no events in a given month, these DO NOT need to be turned in.
  • You may submit these when you submit monthly denominator forms, or as you complete them.

Prospective Event Forms

Download the RTI Prospective Event form (Appendix A) and follow the Table of Instructions (Appendix B) as a guide to completing the form. Further Definitions, Tables and Algorithms for Surveillance (Appendix E) are also provided for reference.

Denominator Forms

Appendix C is used to report daily census and prescriptions, and should be completed monthly regardless of whether there are any RTI events. Appendix D provides further details on how to complete the Denominator Form (Appendix C).

Quick Reference Guide

Consult this guide when you have questions about some of the nuances involved in the filling out of forms.


This presentation covers the approach to the NHSN RTI Pilot Surveillance: how to track, what to track, and what to report.

Further Training: Case Study

This video was created by the CDC to help train participating sites on how to use the forms. It walks through a few case studies to give some example-based assistance on the forms.