[Template] Institutional Contact Tracing [PF-ID]
These are some of the details that an organization should attempt to collect when there is a suspected case of infection. This template will provide a means to trace individuals who have been in contact with the "alleged" inflected person. It is to be recorded so that it will assist the authorities when the "alleged" infected person is identified.
Personal Particulars
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Need Not Enter Information |
Name |
NRIC/ Passport No. |
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S/N |
Record Source/ Hospital |
Case IC |
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Date of Birth |
Nationality |
Sex |
Age |
Race |
Health Status (Well / Unwell) |
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Residential Address and Contact Details
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Blk No. |
Floor |
Unit No. |
Building Name |
Street |
Postal Code |
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Home Tel No. |
Office Tel No. |
Hand Phone No. |
Occupation |
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Details of Case Contact |
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Main Contact Category |
Relationship to Case |
Location of Exposure |
Date of Last Exposure |
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Office Address |
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Blk No. |
Floor |
Unit No. |
Building Name |
Street |
Postal Code |
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Do Not Need To Enter Information (Optional)
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To Quarantine? YES / NO |
Start Date |
End Date |
HQO Number |
Remarks* e.g. Wearing N95 mask? Overseas? Referred to CDC? |
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Reference GuideGoh, M. H. (2016). A Manager’s Guide to Implement Your Infectious Disease Business Continuity Plan, 2nd Edition. GMH Pte Ltd. |
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