6/25/2019
Registration Form
On-line Disease Reporting
Michigan School Building Weekly Report of Communicable Disease
https://www.accesskent.com/SchoolReporting/
To register for the online reporting system, complete this form and return by mail, fax, or e-mail. Your registration
will be processed within 3 business days and you will receive an e-mail confirmation when your registration is
complete. You do NOT need to re-register each year. If there are changes to the name, address, or phone number
of your school, or if you have forgotten your username and password, please call the KCHD Communicable
Disease Unit at 632-7228.
• Mail: Kent County Health Department
Communicable Disease Unit
700 Fuller Ave NE
Grand Rapids, MI 49503
• Fax: 632-7085
• E-mail Christopher.Eakin@kentcountymi.gov
IMPORTANT NOTE: If you submit reports from more than one school each week, you will need a different
username and password for each school.
Name: _____________________________________ Title: _________________________________
School: _____________________________________________________________________________
(Please specify if your school is a preschool, daycare, or SACC located within an Elementary, Middle, or High School)
ID or License Number (9 or 10 digit number issued by the State of Michigan): 41_______________
Address: ____________________________________ City: _____________________ Zip: _______
Phone: (616) Fax: (616) n
E-mail _______________________________________________
Please indicate your preferences below for your username and password. These are case-sensitive, so please
type or print clearly.
Username_______________________________ Password________________________________
Instructions for the online system can be found on the Kent County Health Department website at:
https://www.accesskent.com/Health/CommDisease/pdfs/CD_Epid/CD_Reporting_Handbook.pdf
If you have additional questions, please call 632-7228
Date Received ________________
Date Registered ________________ Initials__________
Date Notified User ________________ Notes__________________________________________________
