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
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