This intake form should only be completed by/for residents of Monroe County (Wisconsin) who have been identified as a close contact for a confirmed case of COVID-19.
"Close contact" is defined as:
- Had direct physical contact with the person (for example, a hug, kiss, or handshake).
- Were within 6 feet of the person for a total of more than 15 minutes in a single day (includes a single encounter or multiple encounters within a single day adding up to 15 minutes or more).
- Had contact with the person's respiratory secretions (for example, coughed or sneezed on; contact with a dirty tissue; shared a drinking glass, food, towels, or other personal items).
- Live with the person or stayed overnight for at least one night in a house with the person.
Someone is considered "infectious" beginning 48 hours before symptoms started through the date that they are released from isolation, or for cases who didn't have symptoms when they were tested, 48 hours before their test specimen was collected that returned positive.
Please provide the requested information below. Sharing it will help us to ensure quick protection of you, your family, friends, and our community. Your information will be kept confidential and nobody but the health department will have access to your responses. Thank you for your help.
For more information on COVID-19 exposure guidance, visit https://healthymonroecowi.org/covid-19/