Self-Isolation and Self-Quarantine

Home Assessment Checklist

for Coronavirus Disease 2019 (COVID-19)

To aid case investigators and contact tracers in assessing ability to safely isolate

or quarantine at home, and the need for additional social support.

CS317305 05/29/2020

As a case investigator or contact tracer, part of your role is to determine how much social support an individual needs to be able to 

successfully and safely self-isolate or self-quarantine during the COVID-19 pandemic. Social support services must be an integral 

component of your jurisdiction’s case investigation and contact tracing activities. In developing jurisdictional case investigation 

and contact tracing protocols, your program should:

• Define its social support services package and eligibility criteria 

• Ensure that the program has the resources to provide culturally and linguistically appropriate services

and information to patients and close contacts.

While many patients and close contacts will be able to self-isolate and self-quarantine at home with little to no outside support, 

some individuals may require substantially more social support to safely self-isolate or self-quarantine. For some of the most 

vulnerable populations in the United States, self-isolation or self-quarantine could present a hardship. Their adherence to isolation 

and quarantine instructions will greatly depend on their safety, comfort, and health during this period. 

• Some individuals may need additional wrap-around services, such as food and pharmacy delivery, laundry services,

and garbage removal. 

• Those whose employment will be affected by their need to self-isolate or self-quarantine could have

financial issues to deal with. 

• There may be additional social support that persons with disabilities need to successfully self-isolate or self-quarantine. 

Individuals who do not have their needs met may struggle to self-isolate or self-quarantine and therefore become a risk for further 

spread of COVID-19. Providing social support should be a priority for your health department’s case investigation and contact 

tracing plans.

You can adapt the following checklist to help assess each patient’s and contact’s ability to safely self-isolate or self-quarantine and 

determine what support services they need to do so. For any statement on the checklist where your answer is “no” or “unsure,” you 

should refer to local protocols to determine whether resources are available to provide that support service.

The patient/contact... YES NO UNSURE NA

Has access to a private bedroom or the ability to designate a private bedroom

Has access to a private bathroom or the ability to designate a private bathroom

Has reliable access to potable water in the home

Has access to laundry services without leaving their home

Is able to dispose of garbage and refuse without leaving their home

Has reliable access to groceries and/or food delivery without leaving their home
2

The patient/contact... YES NO UNSURE NA

Has reliable access to needed medication without leaving their home

Has remote access to a primary care provider

Has access to private transportation in case specialty care is needed that cannot be offered remotely

Has remote access to mental health services (If needed)

Has access to substance use and misuse treatment services (if needed)

Is able to isolate/quarantine without fear of abuse or domestic violence in the home

Is healthy enough to receive care at home (if needed)

Has caregivers who are healthy and available (if needed)

Has reliable access to cooling in the home (as appropriate)

Has reliable access to heating in the home (as appropriate)

Has reliable internet access to check-in with contact tracers to report health status, as well as

to communicate with family and friends

Has reliable telephone access to check-in with contact tracers to report health status, as well as

to communicate with family and friends

Has the ability to arrange care for pets during the isolation/quarantine period (if needed)

Is stably housed; there is no concern that they will have to vacate the home during the

isolation/quarantine period

Is able to isolate/quarantine without or with only minimal financial impact

- Has access to paid sick leave through their employer

- Is able to continue working remotely

- Is not the sole or primary earner for the household

- Is able to ensure their job security upon release from isolation/quarantine

- Is financially secure if unemployed or retired

Has the ability to arrange for childcare (if needed)

Has the ability to arrange for the care of other dependents (if needed)

Has remote access to religious services (if needed)

Is capable of adhering to recommended precautions, along with their household members,

during the isolation/quarantine period

Is able to assess/understand if/when they need to seek medical attention

Has access to basic health monitoring and infection prevention supplies

- Face coverings

- Gloves

- Hand sanitizer

- Disinfectant

- Thermometer