This tool is to be used by health care facilities that have either cared for or admitted COVID-19 patients. This form is to be completed for all health workers who have been exposed to a confirmed COVID-19 patient in a health care facility. It is intended to be an operational tool used by health care facilities once a COVID-19 patient has been identified within the facility. This tool will help determine the risk of COVID-19 virus infection of all HCWs who have been exposed to a COVID-19 patient and then provides recommendations for appropriate management of these HCWs, according to their infection risk.