Coronavirus disease (COVID-19) technical guidance by WHO Household transmission investigation protocol | Page 40

Symptom diary for household contacts of confirmed cases (Day 1–28)
Symptom diaries will be provided to each household contact, for them to record the presence or
absence of various signs or symptoms for up to 28 days (minimum 14 days) after the administration
of the initial contact questionnaire (Form 1B).
The symptom diary template provided below is generic. In the context of a new virus with uncertain
clinical presentation and spectrum, symptom diaries may be broadened to include vomiting,
diarrhoea, abdominal pain, etc., as relevant, and may be altered to include symptom data for longer
than 28 days.
In the event the contact develops any of these symptoms, ask him/her to inform your local public
health team.
Day
Symptoms*
0 No symptoms
(check if none
experienced)
□ None Fever
≥38 °C
□ Yes □ No Runny
nose
□ Yes □ No
1 □ None □ Yes □ No 2 □ None 3 Cough
□ Yes □ No Sore
throat
□ Yes □ No Shortness of
breath
□ Yes □ No
□ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No
□ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No
□ None □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No
4 □ None □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No
6 □ None □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No
7 □ None □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No
8 □ None □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No
9 □ None □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No
10 □ None □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No
11 □ None □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No
12 □ None □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No
13 □ None □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No
14 □ None □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No
□ None □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No □ Yes □ No
Other
symptoms:
specify
…
28
*Please select None for No symptoms. If no symptoms are experienced, then consider the entry
complete.
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