Coronavirus disease (COVID-19) technical guidance by WHO Household transmission investigation protocol | Page 39

Form 5: Laboratory results reporting form– for confirmed cases and household contacts (Day 1, 7, 14, 28)
This table will need to be completed for every specimen collection at each point at the baseline and in the follow-up for case and households contact,
depending on the chosen specimen-collection schedule.
1a. Virology testing methods and results:
Complete a new line for each specimen collected and each type of test done:
Laboratory
Date sample
collected
identification
(dd/mm/yyyy)
number
___/___/___
Date sample
received
(dd/mm/yyyy) Type of sample
□ Nasal swab
___/___/___
□ Throat swab
□
Nasopharyngeal
swab
□ Other, specify:
Type of test
□ PCR
□ Whole genome
sequencing
□ Par al genome
sequencing
□ Other, specify
Result
□ POSITIVE for COVID-19
Result date
(dd/mm/yyyy)
___/___/___
□ NEGATIVE for COVID-19
□ POSITIVE for other
pathogens.
Please specify which
pathogens:
Specimens shipped
to other laboratory
for confirmation
□ Yes
If Yes, specify date
___/___/___
If Yes, name of the
laboratory:
□ No
1b. Serology testing methods and results:
Complete a new line for each specimen collected and each type of test done:
Laboratory
Date sample
identification
collected
number
(dd/mm/yyyy)
___/___/___
Date sample
received
(dd/mm/yyyy)
___/___/___
Type of
sample
□ Serum
□ Other,
specify:
Type of test
Result ( COVID-19
antibody titres)
Specify type
(ELISA/IFA IgM/IgG,
neutralization assay,
etc.):
□ POSITIVE
If positive, titre:
□ NEGATIVE
□ INCONCLUSIVE
Result date
(dd/mm/yyyy)
___/___/___
Specimens shipped
to other laboratory
for confirmation
□ Yes
If Yes, specify date
___/___/___
If Yes, name of the
laboratory: ____
□ No
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