Red Book: Illness & Infection Form

Red Book: Illness & Infection Record

Clients & Staff
Date entered

DayMonthYear
Date
The person is a
Record all:

Infections (colds and flu included)

Illnesses that take a client or staff out of programme/work for 3 or more days OR

Illnesses that 3 or more clients or staff have simultaneously.

Positive cases of COVID-19
Name of client/staff who is ill/has an infection

First NameLast Name
Client/staff complaint is
Type of Illness
Eg. Nausea/vomitting
Type of infection
Describe other infection
What was the precipitating event? (if client did they arrive ill/infected, have visitors etc)
How long was the client/staff excluded from programme due to illness/infection? (in days)
Date symptoms started

DayMonthYear
Date
First day off work/programme

DayMonthYear
Date
Last day off work

DayMonthYear
Date
Was the client/staff contagious while at RLNZ?
Notes about contagious nature
Clients notified?
Family notified?
Any visitors signed in notified?
Health department required to be notified?
Has appropriate cleaning been undertaken?
Describe cleaning
To date, has anyone else (staff, clients, visitors) notified us of a related illness/infection?
Recommended actions
Recommended actions by staff member
Name of staff member completing this form

First NameLast Name
Should be Empty:

Red Book: Illness & Infection Record