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Walloon Lake Swimmer's Itch Reporting Form
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* Indicates required question
Email
*
Your email
Todays Date
MM
/
DD
/
YYYY
Do you have any of the following symptoms? (Check all that apply)
*
Tingling or itching of the skin
Small reddish pimples
Small blisters
No symptoms
Required
Please provide a description of the lake location where you think you may have gotten Swimmer's Itch.
*
Your answer
Enter the date of your latest swimming activity.
*
MM
/
DD
/
YYYY
Enter the approximate time of day of your latest swimming activity.
*
Time
:
AM
PM
Wind Direction
*
Onshore (Waves moving towards the shoreline)
Offshore (Waves moving away from the shoreline)
Along shore (Waves are moving lateral to the shoreline)
No wind
Don't Know
What apparel were you wearing?
*
Your answer
Approximately how deep was the water you were swimming in?
*
0-2 ft
3-5 ft
6-10 ft
10+ ft
Required
Have you gotten Swimmer's Itch before this incident?
*
Yes
No
Maybe
If you have gotten Swimmer's Itch before, please describe.
*
Your answer
How old are you?
*
Your answer
Are you part of the rashguard study?
*
Yes
No
No, but I would like more information.
Name the brand and size of the rash guard you wore during the time in the water.
Your answer
How long were you active in the water? (minutes)
Your answer
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