Templates
COVID contact tracing form

COVID contact tracing form

Effectively track and manage COVID-19 exposures with this comprehensive contact tracing form. Capture personal details, exposure dates, and symptoms to ensure thorough monitoring and risk mitigation.

Use this template with Lumiform

  • Customize this template or build your own
  • Fill out templates via mobile app
  • Get reports and analyse your data
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Learn more
or Download template as PDF
COVID contact tracing form

Effectively track and manage COVID-19 exposures with this comprehensive contact tracing form. Capture personal details, exposure dates, and symptoms to ensure thorough monitoring and risk mitigation.

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

COVID contact tracing forms are essential tools for tracking potential virus exposure and preventing outbreaks. This template captures crucial personal information, exposure details, and symptom data to quickly identify close contacts of confirmed cases. For example, when an employee tests positive, you can immediately trace their interactions, notify potentially exposed individuals, and implement necessary safety protocols.

According to the World Health Organization, around 6 in every 100 people who have COVID-19 get post-COVID condition. This template helps you protect your team’s health while maintaining comprehensive documentation for public health reporting requirements.

Related categories

Preview of the template
Page 1
Personal Information
Full Name
Email Address
Phone Number
COVID-19 Exposure Details
Date of Exposure
Location of Exposure
Were you in close contact with someone who tested positive for COVID-19?
Symptom Monitoring
Have you experienced any COVID-19 symptoms in the past 14 days?
If yes, please list the symptoms
Have you taken a COVID-19 test?
If yes, what was the result?

Frequently asked questions

How do I determine what counts as “close contact” on my COVID contact tracing form?

Close contact typically means being within 6 feet of an infected person for a cumulative total of 15 minutes or more over 24 hours. Include this definition on your form instructions to ensure accurate reporting. For healthcare settings or high-risk environments, you might need more stringent criteria based on local health department guidelines.

How can I modify this COVID contact tracing form for my workplace?

Customize the exposure location section with specific areas in your workplace (conference rooms, departments, common areas). Add questions about workplace-specific interactions like shared equipment or vehicles. Consider including a section for work schedule details to identify potential exposure windows in your particular setting.

What follow-up actions should I take based on COVID contact tracing form responses?

For positive cases, immediately implement your isolation protocol and notify close contacts about potential exposure. For symptomatic individuals awaiting test results, recommend temporary isolation. Create a structured follow-up system to check on both infected individuals and their contacts regularly throughout the recommended quarantine period.

What information should I provide to contacts identified through this form?

Inform contacts about their potential exposure date without revealing the identity of the positive case. Provide clear guidance on testing recommendations, symptom monitoring, and quarantine protocols based on their vaccination status. Include resources for mental health support and practical assistance during isolation periods.

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.