DHS Logo

 
Page 1 of 1
 
 Algae-Related Illness Report Form  
 Please use this form to report a human or animal illness or death that you think was related to exposure to blue-green algae. If you have questions about this form, please call Emmy McAuliff at 608-267-3242 or email her at emelia.mcauliff@wi.gov. Thank you for reporting this incident to us. We are working hard to improve the health of all Wisconsin residents and visitors.  

 
1.
 
M/d/yyyy
   
2.
 

 

 

 
   
3.
 
   
4.
 
   
5.
 

 

 

 

 
   
6.
 
   
7.
Enter at least 1 response and no more than 3 responses.
 

 

 

 
   
8.
 
   
9.
*
 
   
10.
 
   
11.
 
M/d/yyyy
   
12.
 
   
13.
 
   
14.
 
   
15.
 

 
   
16.
 
   
17.
 
   
18.
 
   
19.
 
   
20.
 
   
21.
 
   
22.
 
   
23.
 
   
24.
 
   
25.
 
   
26.
 
   
27.
 
   
 
 
 
 Cancel  Save  Submit   

* indicates a required field


Protecting and promoting the health and safety of the people of Wisconsin.