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AOC-1025.3 Doc. Code: OQ Rev. 3-20 Page 1 (Administrative Office of the Courts)

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8. The affidavit and/or testimony of qualified witnesses, including ___________________________________________
______________________________________________________________________________, has indicated that
________________________________________ has come into contact with _______________________________
_________________________________________________ who, it has been confirmed, is infected with 2019-nCoV.
This contact occurred on ________________________________________________, and in the following manner:
_________________________________________________________________________________________.
This contact was sufficient for ____________________________________________________________________
to have transmitted this disease to ________________________________________.
[individual's name]
[identify individual(s) infected with 2019-nCoV]
[list means of contact in detail]
[individual's name]
[date(s) of contact]
[names and titles of relevant witnesses and describe their association with the individual]
[names and titles of relevant witnesses and describe their association with the individual]
[identify individual(s) infected with 2019-nCoV]
[identify individual(s) infected with 2019-nCoV]
5. Clear and convincing evidence shows that those people who are in physical contact with or in the proximity of less than
6 feet of an individual infected with this disease, or have had contact with a surface or object that is contaminated with
2019-nCoV, are likely to exhibit symptoms within 2 to 14 days, which period of time is referred to herein as the “incubation
period”. Thus, the clear and convincing evidence suggests that this disease is easily transmissible from person-to-person.
ORDER FOR QUARANTINE OF INDIVIDUAL
PURSUANT TO KRS 212.245(6)
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AOC-1025.3 Doc. Code: OQ
Rev. 3-20
Page 1 of 3
Commonwealth of Kentucky
Court of Justice www.kycourts.gov
KRS 212.245; 902 KAR 2:030, 050
Case No. ____________________
Court ________________________
County ______________________
Division ______________________
1. The _______________________________________________ has received reports of increasing numbers of ill people
exhibiting symptoms of a disease that has in its common course severe disability or death.
[local health department name]
3. 2019-novel Coronavirus (2019-nCoV) is a new communicable disease that has not been previously identified in the
world. 2019-nCoV meets the definition for “severe acute respiratory syndromes” as set forth in federal Executive Order
13295, as amended by Executive Order 13372 and 13674, and is a federally quarantinable communicable disease. It is
characterized by fever, cough, and shortness of breath and can progress to severe respiratory illness requiring
hospitalization and mechanical ventilation and can lead to death.
IN RE: QUARANTINE OF ___________________________________________________________,
[Individual's Name]
2. That since ______________________, 2_____ until the date of this Order, over ____________ people have been
stricken with this disease in Kentucky and ____________ people have died.
[applicable number]
[applicable number]
[date of first case report]
7. The most effective method currently known to medical science to contain and curtail the spread of this disease is the
isolation of anyone who has the symptoms identified above at Paragraph 3, and the quarantine of those who have been
exposed to a person infected with this disease for the duration of the incubation period, as identified above at Paragraph 5.
6. There are no known preventive medications for this disease at this time.
4. 2019-nCoV is spread from person-to-person among close contacts. According to the Center for Disease Control and
Prevention, person-to-person spread is thought to occur mainly via respiratory droplets produced when an infected
person coughs or sneezes. These droplets can be inhaled into the lungs and in the mouths or noses of people who are
in close contact. Further, this disease may be spread from contact with contaminated surfaces or objects.
The COURT, having received evidence in this matter, and being otherwise sufficiently advised, now FINDS:
AOC-1025.3
Rev. 3-20
Page 2 of 3
Case No. ______________________________
9.
.
has undertaken these activities since coming into contact with
and that
comes into contact with numerous individuals on
a regular basis through his/her activities as
,
has indicated that
The affidavit and/or testimony of qualified witnesses, including
________________________________________
___________________________________________
___________________________________________________
________________________________________
_________________________________________________
[list applicable profession or personal undertakings]
[individual's name]
[individual's name]
[identify individual(s) infected with the disease]
[names of relevant witnesses]
pursuant to exercises of such authority.
is the agency with the authority to control the spread
of infectious diseases and the responsibility to provide medical care, supervision, and other necessities for
12.
The _______________________________________________
________________________________________
[local health department name]
[individual's name]
1. had the authority to issue an order of quarantine to
________________________________________ pursuant to KRS 212.040, 212.245(5), and 902 KAR 2:050.
The _______________________________________________
[local health department name]
[individual's name]
10.
requires quarantine in his/her home or other appropriate facility.
's exposure to 2019-nCoV, as described in Paragraph 8,
Due to
________________________________________
________________________________________
[individual's name]
[individual's name]
11.
is infected with 2019-nCoV.
would otherwise come in contact
from acquiring this disease, in the event
in his/her home or other appropriate facility will
reasonably protect those with whom _
Quarantine of ________________________________________
_______________________________________
________________________________________
[individual's name]
[individual's name]
[individual's name]
.
from undertaking
activities potentially harmful to the public’s health, the issued
an order of quarantine to on , 2020,
which the COURT has received as Exhibit
13.
Pursuant to such authority and in an attempt to prevent ________________________________________
_______________________________________________
________________________________________ _________________________
____________
[date of order’s issuance]
[local health department name]
[exhibit number]
[individual's name]
[individual's name]
14.
.
has failed to comply with this order, as evidenced by:
, has indicated that
The affidavit and/or testimony of qualified witnesses, including
______________________________________________________________________________
___________________________________________
________________________________________
_____________________________________________________________________________________________
[individual's name]
[list activities demonstrating noncompliance in detail]
[names and titles of relevant witnesses]
[names and titles of relevant witnesses]
The COURT now MAKES the following conclusions:
2. This CIRCUIT COURT has jurisdiction over this action pursuant to KRS 212.245(6).
[individual's name]
3.
’s quarantine
order.
___________________ to comply with the
Pursuant to KRS 212.245(6), this COURT has the power to issue an injunction compelling _____________________
_______________________________________________
[local health department name]
AOC-1025.3
Rev. 3-20
Page 3 of 3
Case No. ______________________________
Distribution: County Attorney
Local Health Department
Individual subject to this Order
This order shall expire 14 days after its issuance.
4.
(as recited above
at Paragraphs 9 and 14), constitute clear and convincing evidence that
The nature of the disease at issue (as recited above Paragraphs 1, 3, and 4),
_____________________________________
must be placed under an order of quarantine so as to protect the public’s health.
(as recited above at Paragraph 8), and the conduct of
’s contact with __________
______________________________
________________________________________________________________________
________________________________________
[individual's name]
[identify individual(s) infected with 2019-nCoV]
[individual's name]
[individual's name]
[individual's name]
until this period of time has elapsed, on , 2020.
is enjoined from leaving
for a period of 14 days.
Therefore, it is ORDERED, ADJUDGED, and DECREED that
___________________________________
________________________________________ be confined
to _________________________________________________________________________
________________________________________ _____________________________________
_________________________
[address for appropriate site of confinement]
[address for appropriate site of confinement][individual's name]
[local health department name]
shall be released from confinement and the
It is further ORDERED, ADJUDGED, and DECREED that upon the expiration of the 14 days,
will bebelieves further confinement of
shall file a final report regarding disposition of this matter with this COURT. In the event the
_________________________
_______________
_________________________
______________________________________________
______________________
________________________________________
necessary, it shall commence appropriate proceedings to that effect in this COURT prior to the expiration of the 14 days.
[individual's name]
[local health department name]
[individual's name]
shall also ensure that The
bears the logistical and financial responsibility
to
Sheriff shall arrange for transportationIt is finally ORDERED, ADJUDGED, and DECREED that the
for all necessary expenses related to confinement or measures necessary to ensure compliance with this Order.
of
have adequate provisions of food, medicine, or other necessities during the period of confinement.
and his or her dependents residing at
_________________
________________________________________ _____________________________________________________,
if necessary. The ______________________________________________
______________________________________________ _____________________________
_________________________________________________________________
[county]
[local health department name]
[local health department name]
[address for appropriate site of confinement]
[individual's name]
[individual's name]
[site of confinement]
q a.m. q p.m.Time: ___________
____________________________________________
Judge's Signature
, 2______ _____________________________
Date
*** Violation of this Order may result in a finding of CONTEMPT by this COURT.
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AOC-1025.3 Doc. Code: OQ Rev. 3-20 Page 1 (Administrative Office of the Courts)

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Completed 28 January 2021

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