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Weekly Report
FAQ
Tracking water related illness for your health and safety
1.
What date did you go into the water?
Please select a time period
Morning
Noon
Night
2.
How would you describe the weather at the time?
Please select
Sunny
Cloudy
Rainy
Snowy
Foggy
Severe (e.g. Thunderstorm, Lightning, Tornado, etc)
Not Applicable
3.
What color was the water?
Please select
Clear
Blue
Green
Brown
Murky
Steel Grey
Cloudy
Blackish
Reddish / Rusty
Other/Unsure
4.
What does the water smell like in and around the water?
Please select
I didn't notice
Fresh
Fishy
Sewage
Chemical
Unsure
Rotten Eggs/Sulphur
5.
Who is this report about?
Please select
Adult
Child
Dog
Horse
Sealife
Birds
Marine Mammals
6. Please choose one or more of the following water activities
(See FAQ)
Swimming
Fishing
Dragon Boating
Surfing
Sailing
Waka Ama
Kayaking
Paddleboarding
Dipping/Immersing
White Baiting
Diving
Jet-skiing
Water Skiing
Canoeing
Water Aerobics
Wind Surfing
Snorkelling
Powerboat Racing
Other
6. Please choose one or more of the following water activities
(See FAQ)
Walking
Playing in Water
Swimming (Pet/Animal)
Drinking Water
Fetching in Water
Running Along Shore
Digging in Sand
Rolling in Water
Wading (Pet/Animal)
Contact with Algae
Other
No signs of life
7.
What location did you go to?
Please select region
Wellington Region
Please select city / district
Please select water site
8.
Do you live near the location of activity?
Yes
No
9.
Please select status
Please select
Ratepayer(Homeowner)
Resident(Renting or Child)
Visitor(From out of area)
Other(Animal/Pet)
10.
Did you feel sick after activity?
Yes
No
11. What symptoms appeared after activity? (Choose one or more)
Ear Aches
Ear Infection
Headaches
Fever
Loose Stools
Rashes on Body
Mouth Ulcers
Blisters near Mouth/Nose
Nausea
Eye Irritation
Respiratory
Stomach Cramps
Vomiting
Body Sores
Other
11.
What symptoms your pet/animal have after the activity? (Choose one or more)
Vomiting
Diarrhoea
Skin Irritation
Eye Irritation
Lethargy / Low Energy
Excessive Drooling
Breathing Issues
Seizure
No Signs of life
Other
Instructions:
Select
Other
if the observed symptoms are not listed above and provide a brief description of the symptoms.
Otherwise select all the symptoms observed.
12.
How many hours after the activity did the symptoms start (within 7 days)?
Please select
Not Applicable
0-6 hours
7-12 hours
13-24 hours
25-48 hours
49-72 hours
73-96 hours
97-120 hours
121-144 hours
145-168 hours
13.
Approximately how many days did symptoms last (within 30 days)?
Please select
Unknown
0-5 days
6-10 days
11-15 days
16-20 days
21-25 days
26-30 days
14.
Sex?
i
Please select
Male
Female
Prefer not to say
Unknown
15.
Ethnicity?
Please select
European (Pākehā)
Māori
Asian
Pacifika
Middle Eastern
Latin American
African
Others
Prefer not to say
Non Applicable
16.
Age?
i
Unknown
17.
Diagnosed by Doctor or Vet?
Yes
No
Unknown
18.
Is it a Communicable Disease?
Yes
No
Your information is used as aggregate data for public health monitoring purposes.
If you feel unwell, seek medical advice and contact
Healthline 0800 611 116
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