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Overview
Case Information
Personal Details
Symptoms
Location/s visited (if applicable)
Location/s visited (if applicable) 1
Close Contacts Information
Close Contacts Information 1
Close Contacts Information 2
Emergency Contact Information
Final Remarks
Overview
Complete
Contact Tracing Form Template
2020-134 / Susan Willis
Inspection score
33.33%
Failed items
0
Created actions
0
Case ID
2020-134
Name
Susan Willis
Location
11 Kumbardang Ave, Miranda NSW 2228, Australia (-34.0303415, 151.1031244)
Date

19th Sep, 2020

10:30 AM PST

Form Accomplished By
Alexa Lynch
Case Information
33.33%
Personal Details
First Name
Susan
Surname
Willis
Age
51
Contact number
62062147
Alternative contact number
45266080
Address
11 Kumbardang Ave, Miranda NSW 2228, Australia (-34.0303415, 151.1031244)
Symptoms
33.33%
Symptom Onset

19th Sep, 2020

10:00 AM PST

Please select all symptoms you are currently experiencing

Cough

Fever

Sore throat

Shortness of breath

Runny nose

Fatigue

Loss of smell/or taste

Other symptoms

No symptoms

Location/s visited (if applicable)
Location/s visited (if applicable) / Location/s visited (if applicable) 1
Location
159 Kingsway, Woolooware NSW 2230, Australia (-34.0477468, 151.1404334)
Date Visited

19th Sep, 2020

Time Arrived

4:30 PM PST

Time Departed

6:30 PM PST

Close Contacts Information
Close Contacts Information / Close Contacts Information 1
Name
Fred Willis
Age
54
Relation to Case
Wife
Last Contact with Case

20th Sep, 2020

11:30 PM PST

Address
11 Kumbardang Ave, Miranda NSW 2228, Australia (-34.0303415, 151.1031244)
Contact Number
82470400
Close Contacts Information / Close Contacts Information 2
Name
Jean Galloway
Age
45
Relation to Case
Neighbor
Last Contact with Case

19th Sep, 2020

4:00 PM PST

Address
7 Kumbardang Ave, Miranda NSW 2228, Australia (-34.030313, 151.1034688)
Contact Number
39409649
Emergency Contact Information
Full Name
Fred Willis
Relationship
Husband
Contact number
82470397
Alternative contact number
Unanswered
Email
NA
Address
11 Kumbardang Ave, Miranda NSW 2228, Australia (-34.0303415, 151.1031244)
Final Remarks
Comments
The patient has begun self-isolation at a nearby inn.
Person Under Investigation
Susan Willis
22nd Sep, 2020 8:03 PM PST
Assigned Contact Tracer
Alexa Lynch
22nd Sep, 2020 8:03 PM PST