Templates
CDC contact tracing form

CDC contact tracing form

Align with CDC guidelines using this contact tracing form. Capture detailed contact information, exposure dates, and symptoms for thorough data collection.

Use this template with Lumiform

  • Customize this template or build your own
  • Fill out templates via mobile app
  • Get reports and analyse your data
Prices start from ░░░ per month
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Learn more
or Download template as PDF
CDC contact tracing form

Align with CDC guidelines using this contact tracing form. Capture detailed contact information, exposure dates, and symptoms for thorough data collection.

Use this template with Lumiform

  • Customize this template or build your own
  • Fill out templates via mobile app
  • Get reports and analyse your data
Prices start from ░░░ per month
Book a demo
Learn more
or Download template as PDF

We developed this CDC contact tracing form template to help you implement thorough contact tracing protocols during disease outbreaks. The form collects personal details, contact information, interaction history, and health status data, enabling you to quickly identify and notify individuals who may have been exposed.

Public health research indicates that to effectively stop COVID-19 spread, practitioners need to isolate new cases and quarantine at least 80% of their contacts within 2-3 days of symptom development. By using this template, you gain a powerful tool for meeting this urgent timeframe, allowing your team to respond swiftly with appropriate isolation and quarantine measures.

Related categories

Preview of the template
Page 1
Personal Information
First Name
Last Name
Phone Number
Email Address
Date of Birth
Gender
Contact Information
Address
City
State/Province
Zip/Postal Code
Country
Interaction History
Have you had close contact with someone diagnosed with COVID-19 in the past 14 days?
If yes, please provide the date of last contact
Have you traveled outside your local area in the past 14 days?
If yes, please list locations and dates of travel
Health Status
Are you currently experiencing any COVID-19 symptoms?
If yes, please select all that apply:
Have you been tested for COVID-19?
If yes, what was the result?
Date of COVID-19 test

Frequently asked questions

How can I customize this CDC contact tracing form for my organization?

You can tailor this template by adding organization-specific questions, modifying symptom lists based on current guidance, and incorporating your organization’s branding. Lumiform’s platform allows you to adjust field requirements, add conditional logic for more targeted questioning, and implement digital signatures for verification.

What should I do with the information collected through this contact tracing form?

Use the collected data to promptly notify individuals of potential exposure, provide guidance on testing and quarantine procedures, and identify patterns that might indicate outbreak clusters. Maintain confidentiality by sharing only necessary information with authorized personnel and public health agencies while documenting all follow-up actions taken.

How can I improve response rates when using this contact tracing form?

Clearly explain the purpose and importance of contact tracing, emphasize confidentiality protections, keep the form completion process under 10 minutes, offer multiple submission methods, and provide assistance for those with language barriers or technical difficulties. Follow up promptly with those who haven’t responded within 24 hours.

This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.