Forms

The generic forms below have been developed by the TRACE Initiative team to support the roll-out of recent HIV infection testing. They are intended to be downloaded, adapted, and utilized by stakeholders in various countries. For technical assistance in adapting the materials to suit specific context and needs, please visit Contact Us.

Participant Tally Sheet



Download

Asante Data Capture Form – Site Level



Download

Recent HIV Infection Surveillance Register



Download

Laboratory Requisition Form



Download

Specimen Tracking Log Health Facility



Download

Specimen Tracking Log Lab



Download

Return of Results Tracking Log



Download

Return of Recency Results Post-Test Counseling Guide



Download

Understanding HIV and Recent Infection Information Sheet



Download

Adverse Events Tracking Register



Download

Example Participant Risk Questionnaire Interview Guide



Download

Readiness Checklist for TOT and Panel Preparation



Download

CQI Monitoring Checklist



Download

CQI Monitoring Checklist (Short Version)



Download

TOT Pre- and Post-Training Assessment



Download

TOT Pre- and Post-Training Assessment Answer Key



Download

TOT Trainee Results Form – Asante



Download

QC and TOT Panel Prep Reference Results Form



Download

RTRI Training and Panel Prep Supply List with Plasma

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16b. RTRI Training and Panel Prep Supply List with DTS



Download Plasma Supply List

Download DTS Supply List

RTRI QC Logbook

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17b. RTRI QC Logbook Job Aid



Download Form

Download Job Aid

Proficiency Panel Prep Reference Results Form



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RTRI Proficiency Testing Results Form (DTS)

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19b. RTRI Proficiency Testing Results Form (Plasma)

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19c. RTRI Proficiency Testing Results Form (RTRI only)

Download DTS Form

Download Plasma Form

Download RTRI Only Form

RTRI Pre-Implementation Checklist



Download

Station Set-Up Checklist



Download

Practical Examination – Direct Observation Checklist (Asante)



Download

Certificate of Completion Template



Download

Participant List



Download