Templates
Contact tracing form

Contact tracing form

Efficiently track and manage interactions to prevent the spread of infectious diseases with this contact tracing form. Document essential details and ensure thorough data collection.

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Contact tracing form

Efficiently track and manage interactions to prevent the spread of infectious diseases with this contact tracing form. Document essential details and ensure 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

When managing potential disease outbreaks, having an organized system for contact tracing is crucial. This contact tracing form captures essential information needed to track exposure: personal details, symptom history, visited locations, and close contacts. You can quickly identify who needs testing or isolation, preventing further transmission.

The US Centers for Disease Control and Prevention emphasizes that contact tracing remains a critical tool for stopping disease spread, especially with asymptomatic carriers. This template helps you maintain comprehensive records that support rapid response during health emergencies, whether you’re managing a school environment or coordinating workplace safety protocols.

Related categories

Preview of the template
Contact Tracing Form
Personal Details
First Name
Surname
Age
Contact number
Alternative contact number
Email
Address
Symptoms
Symptom Onset
Please select all symptoms you are currently experiencing
Cough
Fever
Sore throat
Shortness of breath
Runny nose
Fatigue
Loss of smell/or taste
Other symptoms
No symptoms
Location/s visited (if applicable)
Location
Date Visited
Time Arrived
Time Departed
Close Contacts Information
Name
Age
Relation to Case
Last Contact with Case
Address
Contact Number
Emergency Contact Information
Full Name
Relationship
Contact number
Alternative contact number
Email
Address
Final Remarks
Comments
Person Under Investigation
Assigned Contact Tracer
This template was downloaded 78 times

Frequently asked questions

How can I implement this contact tracing form in my workplace?

Start by introducing the form as part of your workplace safety protocol. Train your team on proper form completion, ensuring privacy concerns are addressed. Make the form easily accessible—digitally through Lumiform or as printed copies at entry points. Establish a secure system for storing completed forms and designate responsible staff for follow-up actions when potential exposures are identified.

When should I notify individuals identified through contact tracing?

Notify close contacts as soon as possible after confirming a positive case, ideally within 24 hours. Prioritize contacts based on exposure risk and vulnerability. Your communication should be clear about potential exposure while maintaining the privacy of the positive case. Provide specific guidance on next steps including testing recommendations and quarantine protocols.

What should I do if someone refuses to complete the contact tracing form?

Acknowledge their concerns respectfully and explain the public health purpose of contact tracing. Offer alternatives like verbal information collection if they’re uncomfortable with written forms. For organizations like businesses or schools, consider establishing clear policies about entry requirements. Remember that building trust is essential for effective contact tracing.

How can I integrate this contact tracing form with our existing health protocols?

Review your current health and safety procedures to identify natural integration points. Train staff who handle other health documentation to include contact tracing in their workflow. Consider using Lumiform’s digital platform to connect contact tracing data with other safety protocols, creating a comprehensive health management system that allows for coordinated response to potential outbreaks.

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.