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Covid-19 Positive Case Reporting
If you test positive for Covid-19 from 19th December - 24th December please complete the following form so that Track and Trace can be completed.
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* Indicates required question
Name:
*
Your answer
Do you have symptoms?
*
High temperature
New, continuous cough
Loss or change to your sense of smell or taste
No symptoms
Date symptoms started?
*
MM
/
DD
/
YYYY
Date when tested?
*
MM
/
DD
/
YYYY
Date when the positive result was received?
*
MM
/
DD
/
YYYY
Last day in the Academy?
*
MM
/
DD
/
YYYY
Please reflect on the 17th & 18th Dec - did you interact with any other members of staff during the school day? e.g. in staffroom or workroom
*
Yes
No
What are the names of the members of staff?
*
Your answer
Were you within 1 metre for 1 minute or 1-2 metres for 15 minutes with those staff members mentioned above? (Please name the member(s) of staff and the metres kept apart below please)
*
Your answer
Please review your timetable for the 17th & 18th Dec. Were you within 1 metre for 1 minute or 1-2 metres for 15 minutes of the students you teach? (Name the student(s) and the metres kept apart below please)
*
Your answer
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