Contact Tracing Form Template

A contact tracing form template is a document that helps health professionals determine who a sick person caught an illness from and track every possible person they have been in contact with while infectious. Use this contact tracing form template to ensure the privacy and confidentiality of patient/ visitor information and improve legibility and traceability of crucial contact tracing data.

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Free Contact Tracing Form Template Checklist

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• Case ID
• Name

Personal Details

• First Name
• Surname
• Age
• Contact number
• Alternative contact number
• Email

Symptoms

• Symptom Onset Date
• Please select all symptoms you are currently experiencing
• Cough

Emergency Contact Information

• Full Name
• Relationship
• Contact number
• Alternative contact number
• Email

Final Remarks

• Comments
• Person Under Investigation Sign
• Assigned Contact Tracer Sign

Contact Tracing Form Template

A contact tracing form template is a document that helps health professionals determine who a sick person caught an illness from and track every possible person they have been in contact with while infectious. Use this contact tracing form template to ensure the privacy and confidentiality of patient/ visitor information and improve legibility and traceability of crucial contact tracing data.

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.