Sorry I was not allowed to send this out to everyones email to make it easier. I have attached the updated form here so you can copy it and use it. Please print these out as fill out any calls you run that there was a suspected or confirmed COVID 19 pt not just if you feel as if you have been exposed. I have added an additional question about how long you were in contact with the pt. Additionally when filling out this form please follow the link provided as it contains definitions and additional information needed to fill out the form properly. 

https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html