PatientCarer accompanying patientProfessional Visitor


less than 15 minutes30 minutes1 hour3 hoursmore than 3 hours



YesNo


YesNo


CloseCasualNo

*CLOSE defined as: Spending > 15 minutes face to face OR sharing a closed space > two hours with a person who is a confirmed case 48 hours before they showed symptoms or once they showed symptoms.

** CASUAL defined as: Spending < 15 minutes face to face OR sharing a closed space < two hours with a person who is a confirmed case 48 hours AND had symptoms at the time.


YesNo

If Yes:


NegativePositive


YesNo

If Yes:

Do you have any of the following symptoms:


YesNo


YesNo


YesNo


YesNo


YesNo


YesNo