• COVID-19 Case Investigation Form

    Gallatin City-County Health Department

  • Thank you for choosing to complete our contact tracing survey. Due to the high volume of COVID-19 cases, Gallatin City-County Health Department is requesting your assistance in collecting the following information to assist us in our COVID-19 response efforts. This survey is only for individuals who have tested positive for COVID-19. Please do NOT complete it unless you have had a positive test.

    All form entries are encrypted and your information will only be shared when it is necessary to protect the health of the public. Please submit one form for every positive test within your family. This survey is intended for individuals 18 years of age or older. If you are under 18 please have your parent/guardian complete the survey for you.

    If you have questions and/or would rather complete your contact tracing interview by phone, please call our COVID-19 call center at 406-548-0123.

  • Are you reporting for yourself or someone else?*
  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Sex at birth*
  • Format: (000) 000-0000.
  • What day did you get tested? *
     - -
    2 digit month, 2 digit day, 4 digit year
  • Are you experiencing any COVID-19 symptoms?*
  • Please Mark all of symptoms you have been/are experiencing:*

  • If you or someone you know is showing any of the following symptoms, seek emergency medical care immediately:

    • Trouble breathing
    • Persistent pain or pressure in the chest
    • New confusion
    • Inability to wake or stay awake
    • Bluish lips or face 

    * This list is not all possible symptoms. Please call your medical provider for any other symptoms that are severe or concerning to you.

    Call 911 or call ahead to your local emergency facility: Notify the operator that you are seeking care for someone who has or may have COVID-19.

  • Do you have any of the following underlying health conditions?
  • Are you currently a student at a daycare, K-12 school, or university?*
  • Are you currently an MSU or Gallatin College student?

  • If you are an MSU student and require case management services in order to safely isolate, please call 406-994-3767.

  • Have you notified the school that you have tested positive?
  • What was the last day you attended school?
     - -
    2 digit month, 2 digit day, 4 digit year
  • Do you participate on a sports team or in an extracurricular activity?
  • What is the last day you participated in the activity?
     - -
    2 digit month, 2 digit day, 4 digit year
  • Do you work in any of the following sensitive occupations?*
  • What was the last date that you worked? *
     - -
    2 digit month, 2 digit day, 4 digit year
  • Were you exposed to a positive COVID-19 case in the last 14 days?*
  • Have you traveled outside of your normal state and/or country of residence in the last 14 days?*
  • Have you ever received a COVID-19 vaccine?
  • How many doses of a COVID-19 vaccine did you receive?

  • Close contacts

    A close contact is anyone you were within 6 feet of for 15 minutes or more during your infectious period, regardless of whether you or they were masked. You are able to infect others starting two days prior to your first symptom and for 5-10 additional days starting the day of your symptoms. Please share the information below with anyone that meets the above criteria.

  • Isolation instructions (if you tested positive for COVID-19)

    After you test positive for COVID-19 you must remain isolated until you meet the criteria from the Centers for Disease Control and Prevention (CDC) to be released from isolation. Please stay home and isolate yourself from others to prevent the spread of COVID-19.

    Isolation means staying home for at least 5 days since your symptoms began, or day of your positive test if you are asymptomatic (never develop any symptoms). In order to be released after day 5 of isolation, it is strongly recommended that you continue to wear a mask around others for 5 additional days and the following criteria must be met:

    • You have not had a fever in the last 24 hours (without the use of fever reducing medication); and
    • You do not have a cough, sneezing or other respiratory-like symptoms and other symptoms are resolving.

    If you have access to an at-home test kit, we would encourage you to test at day 5 prior to releasing yourself from isolation.

    If you continue to have respiratory symptoms, you must remain in isolation for the full 10 days from symptom onset and can be released after 10 full days if:

    1. You have had some improvement in symptoms; and
    2. You have not had a fever in the last 24 hours (without the use of fever reducing medication).

    Health Officer Order: https://www.healthygallatin.org/wp-content/uploads/2022/01/HO-2021-002_12.30.2021-Isolation-and-Quarantine.pdf

    Quarantine instructions (if you are a close contact to a positive COVID-19 case)

    Vaccine StatusQuarantine Recommendation
    If you:Then it is recommended that you:

     • Have received a booster shot;

    OR

     • Completed the primary series of Pfizer or Moderna within the last 5 months;

    OR

     • Completed the primary series of J&J within the last 2 months.

     • Wear a mask around others for 10 days.

     • Test on day 5, if possible.

     • If you develop symptoms, get tested and stay home.

     • Completed the primary series of Pfizer or Moderna over 5 months ago and are not boosted;

    OR

     • Completed the primary series of J&J over 2 months ago and are not boosted;

    OR

     • Are unvaccinated.

     • Quarantine at home for 5 days. After that continue to wear a mask around others for 5 additional days.

     • If you are unable to quarantine, wear a mask around others for 10 days.

     • If you develop symptoms, get tested and stay home.

     Source: https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html

  • Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year
  • Enter the day of symptom onset (or test date if asymptomatic)*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Last date of isolation if fully asymptomatic or if mildly symptomatic with some improvement and you have NOT had a fever in the past 24 hours:
     - -
    2 digit month, 2 digit day, 4 digit year
  • Last date of isolation if symptoms are severe and/or not improving:
     - -
    2 digit month, 2 digit day, 4 digit year

  • Thank you for completing our case investigation survey. Please print this page for your own records or to provide documentation to your employer or school.

    If you require assistance from case management services in order to safely isolate, please contact our call center at 406-548-0123.

  • High Risk Close Contacts
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