Data entry form for close contact persons of a person with COVID-19 infection

Have you had contact with a confirmed case of COVID-19 and would like to contact the Pankow Health Authority?
Then use the following form to contact the Pankow Health Office. By providing your complete data you will make the work of the health office staff easier. This way you support the quick follow-up of contact persons and help the Health office staff to react quickly and purposefully to possible new cases. Please note that an initial contact by individual mail to cannot be processed.

By sending the form below, you are stating that you are a possible contact person at the Pankow Health Office.
The Pankow Health Office is responsible for citizens with a registration address in Pankow (zur Seite des RKI) or with a predominant stay in Pankow.
Please describe your contact to the positive tested person as precisely and in detail as possible and provide all the necessary information requested. This saves the staff a lot of work and enables the public health department to process the inquiries effectively.
The employees of the health departement will check if a PCR-test at our office is necessary. You will get a nitofication about your qarantine, but due to the workload it might be delayed.

Close contact person according to the contact categories of the RKI recommendations:

  • Cumulative at least 10 min close contact without proper safety equipment (medical Face-Mask or FFP2-mask)
  • conversation with the infected person (face-to-face contact regardless of the duration) without proper safety equipment
  • direct body contact with secretions or body fluids or contact person was exposed to a high aerosol concentration regardless of the distance, e.g. celebrating, singing together or doing sports indoors without adequate ventilation.

Close contacts are required to isolate themselves for 10 days from the last contact with the infected person.

It is possible to end the isolation on day 7 if:
  • a PCR-test is negative and was done on day 7 after the contact or later. If the test was done earlier the isolation stays the same.
  • a PoC-Antigen-Test is negative and was done 7 days after the contact. If the test was done before the isolation stays the same

You are not required to isolate yourself if:

  • You had a PCR-confirmed infection, starting 28 days until 90 days after the test
  • You are vaccinated twice (15 days after the second jab) until 90 days with an EU-approved vaccine
  • You had a PCR-confirmed infection and you also have received an EU-approved vaccine at least once (until 3 months after the infection or vaccination)
  • You have already received a booster-shot (vaccinated three times)

We thank you for your cooperation and wish you all the best!
Your health office Pankow

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Required fields are marked with a star-sign *.

Your personal data

Example: (030) 123 456 89


With your consent to the use of your e-mail address, you agree that the Pankow Health Department can contact you via this address and, if necessary, orders and findings may be sent to you. Please also check your SPAM folder for messages from the health department.

The advantage of transmitting via email is that the findings and orders can be sent at short notice. We would like to point out, however, that sending by e-mail can only be an unencrypted – and therefore unsecured – transmission. If you decide not to send it by email, delivery will be made by post with the usual delivery times.

Information about your with COVID-19 infected person

Example: 22.02.2022

Example: (030) 123 456 89

Example: 22.02.2022

In case you don’t have all the necessary information, please contact the infected person or the institution that informed you about the fact that you are a contact person to ask for the required data.

Example: 22.02.2022

Example: 22.02.2022

Further information about you

Example: 22.02.2022

Example: 22.02.2022

Example: 22.02.2022

Example: 22.02.2022

Example: 22.02.2022

Information über die Gesetzliche Grundlage

Hinweis: In diesem Formular werden "besonders schützenswerte Daten" nach der DSGVO Art. 9 verarbeitet

Internetseite des Datenschutzbeauftragten

Contacting the Data Protection Officer

Boris Hube

Bezirksamt Pankow von Berlin
Breite Straße 24A-26
13187 Berlin

E-mail: Contact