Coronavirus disease (COVID-19) technical guidance by WHO Household transmission investigation protocol | Page 33

Occupation (specify location/facility)
□ 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 contact if different from
address of primary case.
Date of last contact with the confirmed case (dd/mm/yyyy)
Does the contact share a room (or usually share a room) with
the primary case?
Number of days during the time the case was ill at home that
were spent in contact with case (refer to household contact
definition).
Did the contact take care of the case during the time he/she
was ill at home before hospitalization?
Did the contact hug the case during the time he/she was ill at
home before hospitalization?
Did the contact kiss the case during the time he/she was ill at
home before hospitalization?
Did the contact shake hands with the case during the time
he/she was ill at home before hospitalization?
Did the contact share a meal with the case during the time
he/she was ill at home before hospitalization?
Did the contact eat with hands from the same plate as the
case during the time he/she was ill at home before
hospitalization?
Did the contact share a drinking cup/glass with the case
during the time he/she was ill at home before
hospitalization?
Did the contact share utensils with the case during the time
he/she was ill at home before hospitalization?
Did the contact sleep in the same room as the case during
the time he/she was ill at home before hospitalization?
Did the contact share a toilet with the case during the time
he/she was ill at home before hospitalization?
6a. Symptoms in contact
Has the contact experienced any respiratory symptoms (sore
throat, runny nose, cough, shortness of breath) in the period
from 14 days before symptom onset in the confirmed case
until the present?
Has the contact experienced any respiratory symptoms (sore
throat, runny nose, cough, shortness of breath) in the period
up to 14 days after the last contact or until the present date,
whichever is the earlier?
Date (dd/mm/yyyy) and time of first symptom onset
Fever (≥38 °C) or history of fever
___/___/___
□ 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
□ Yes □ No □ Unknown
□ Yes □ No □ Unknown
□ Yes
□ No
If No, skip to Section 5c
□ Yes
□ No
___/___/___
□ am □ pm
□ Asymptoma c □ Unknown
□ Yes □ No □ Unknown
If Yes, date ___/___/___
If Yes, specify maximum temperature:
-33-
°C