Red Book: Illness & Infection Form

Red Book: Illness & Infection Record

Clients & Staff
Date entered

DayMonthYear
Date
The person is a

ClientStaff
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?

YesNo
Notes about contagious nature
Clients notified?

YesNoN/A - not required to be notified, low/no risk
Family notified?

YesNoN/A - not required to be notified, low/no risk
Any visitors signed in notified?

YesNoN/A - not required to be notified, low/no risk
Health department required to be notified?

YesNoUnsure
Has appropriate cleaning been undertaken?

YesNo
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