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COVID-19: CDC and HUD Screening Forms
COVID-19: CDC and HUD Screening Forms

CDC and HUD specific COVID-19 tracking forms for ETO Clients.

Updated over a week ago

Bonterra has developed five screening forms that can be imported in to any HMIS or non-HMIS site. Please contact support at and request for the COVID forms to be imported to your instance.

Forms 1-3 were available before forms 4-5. Please let support know if you require all the forms or just the newest ones. 

1. Coronavirus Disease 2019 COVID -19 Risk Assessment and Public Health Management Decision Making

An eight question form with conditional logic to show the participants risk (High, Medium, Low, None) according to the CDC.

2. COVID-19 Client Triage Tool: Atlanta, GA CoC Example

The Atlanta Continuum of Care (CoC) developed a triage-screening tool to assist their shelters and housing programs modify shelter management strategies in light of the emerging COVID-19 concerns. The triage-screening tool focuses on reorganizing the intake workflow to effectively identify symptomatic and asymptomatic people entering congregate sites. 

An eight question form with conditional logic to show the participants risk according to the CoC.

This form has place holders for demographics which, upon import, should be replaced with demographic cross-references fields (i.e. location, gender, etc.).

3. HUD COVID-19 Screening Tool

Many communities have screening hotlines or call centers, which should be utilized by the homeless provider community wherever possible. To assist shelters in triaging placement for shelter beds and/or determining when to send a participant for a COVID-19 test, the following tool can be followed

There are a series of questions in this form to assist end users in determining where participants are in the triage/testing process.

4. COVID-19 Impact Assessment

A form specifying the need for services as a result of COVID-19. This can help organizations track impact and services based on COVID-19. 

5. COVID-19 Services & Safety Checklist

A form specifying the safety and services available to a participant during COVID-19. 

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