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Sample Temporary Isolation Order for Pandemic Influenza


Drawn from the Santa Clara County Public Health Department Pandemic Influenza Preparedness and Response Plan, this document provides a sample of a temporary isolation order that can be used to hold individuals temporarily until the Health Officer is notified and able to evaluate whether there is a need for additional action. This information should be modified in order to meet the requirements of other states and localities.

Primary Toolkit:

EQUIPh Toolkit

Keyword Area:

Advanced Practice Centers


Institutional Author:

Santa Clara Health Department





The NACCHO Toolbox is a repository of available resources to help local public health practitioners. Tools are produced by local, state, and federal agencies, as well as academic institutions and other stakeholders. The contents of this Toolbox are solely the responsibility of the authors and do not necessarily reflect any official recommendations of NACCHO. NACCHO makes no express or implied warranty with respect to the contents and disclaims liability for any damages arising from or connected to the use of the material in this Toolbox.