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Contact Tracing Form Template

Streamline your contact tracing efforts with ease

As COVID-19 continues to impact our lives, efficiently tracking potential exposure is critical. This Contact Tracing Form template helps health professionals, nonprofits, and businesses gather essential data quickly and accurately. With this form, you can keep your community safe, monitor spread effectively, and comply with local health guidelines, all while offering a user-friendly experience that works on any device. Explore our live template to simplify your contact tracing today.

Use this Template (FREE) Live Preview
Full name
Phone number
Email address (optional)
Home address (optional)
Date of visit
Arrival time
Departure time (optional)
Number of people in your party
Area or section visited (optional)
Setting visited
Indoors
Outdoors
Both
Not sure
Not applicable
Approximate duration of stay
Under 15 minutes
15-30 minutes
31-60 minutes
More than 60 minutes
Not sure
In the past 24 hours, have you had any new symptoms not related to a known condition?
Yes
No
Prefer not to say
If yes, list symptoms (optional)
Have you tested positive for COVID-19 in the past 10 days?
Yes
No
Prefer not to say
In the past 14 days, have you been in close contact with someone who tested positive for COVID-19?
Yes
No
Not sure
Prefer not to say
In the past 14 days, have you traveled internationally?
Yes
No
Prefer not to say
If you traveled, list countries or regions visited (optional)
In the past 14 days, have you visited any of the following higher-risk settings? (Select all that apply)
Healthcare facility
Long-term care facility
Large indoor event
Public transport (long trip)
None of the above
Prefer not to say
May we contact you for public health follow-up related to this visit?
Yes
No
Preferred contact method
Phone call
Text message
Email
Any of the above
Prefer not to say
Best time to contact you (optional)
Type your full name as signature
Date of completion
I confirm the information provided is accurate to the best of my knowledge.
Yes
No
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When to use this form

Use this template when your clinic, campus, or workplace needs to document exposures and notify people fast. It fits outbreak response, onboarding of new cases, and screening after a positive test. Collect names, phones, emails, locations, dates, and symptom details. Capture recent trips with the Travel declaration form. If you coordinate testing, link results with the COVID-19 Lab report form. For cases that require movement between facilities, pair your workflow with the Hospital transfer form. The form helps you build a clear timeline, map likely contacts, and prioritize outreach. With complete, structured data in one place, your team can act quickly, reduce risk, and keep services running.

Must Ask Contact Tracing Questions

  1. What date and time did your symptoms start, or when did you test positive?

    This pins down the likely infectious window. It lets you focus outreach on the right days and people.

  2. Where were you in the 48 hours before symptoms or a positive test? List places, dates, and times.

    Location details help you identify exposure sites and notify venues. It also supports cleaning or policy steps at those places.

  3. Who were you within 6 feet of for 15 minutes or more? Include names, phone numbers, and emails.

    Close-contact details are essential for fast notifications. The better the contact info, the faster you can reach people.

  4. Have you traveled in the past 14 days? Include countries, states, flight numbers, and dates.

    Travel can change exposure risk and jurisdiction. These details guide cross-agency coordination.

  5. Do you consent to share your information with healthcare providers and public health for follow-up?

    Clear consent supports privacy requirements and speeds referrals. If discharge documentation is part of your process, coordinate with the Hospital patient release form.

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