Coronavirus disease (COVID-19) technical guidance by WHO Household transmission investigation protocol | Page 30

Occupation □ Health worker □ Work/stay home □ Nursery/primary school/secondary school □ Student □ Other, specify: For each occupation, specify location or facility: 5. Household information Location of household/Address of primary case Household size (number of people who usually live in the house, this will be varied depending on culture). Number of rooms in house Number of bedrooms Age of each household member 6a. Primary case symptoms (from onset of symptoms) Date of first symptom onset (dd/mm/yyyy) Fever (≥38 °C) or history of fever Date of first health facility visit (including traditional care) (dd/mm/yyyy) Total health facilities visited to date ___/___/___ □ No symptoms □ Unknown □ Yes □ No □ Unknown If Yes, specify maximum temperature: °C ___/___/___ □ Not applicable (na) □ Unknown □ na □ Unknown Specify: 6b. Respiratory symptoms Sore throat □ Yes □ No □ Unknown If Yes, date (dd/mm/yyyy): ___/___/___ Runny nose □ Yes □ No □ Unknown Cough □ Yes □ No □ Unknown If Yes, date (dd/mm/yyyy): ___/___/___ Shortness of breath □ Yes □ No □ Unknown If Yes, date (dd/mm/yyyy): ___/___/___ 6c. Other symptoms Chills Vomiting Nausea Diarrhoea Headache Rash Conjunctivitis Muscle aches Joint ache □ Yes □ No □ Unknown □ Yes □ No □ Unknown □ Yes □ No □ Unknown □ Yes □ No □ Unknown □ Yes □ No □ Unknown □ Yes □ No □ Unknown □ Yes □ No □ Unknown □ Yes □ No □ Unknown □ Yes □ No □ Unknown -30-