Staff Vaccination Confirmation Form
Please use this form to let your school leader know if you have received a COVID-19 vaccination recently.

Your response will be held securely and confidentially.  Our Lumen Head of Operations will only share your response directly with the relevant Headteacher so that the school and any individual risk assessment can be revised and updated as required.

PRIVACY NOTIFICATION:
Following the change in government guidance that those who are double jabbed are no longer legally required to self-isolate if they are identified as a close contact of a positive COVID-19 case.
We will now be asking staff their vaccination status, in order for us to support our contact tracing processes.
Your vaccination status will be obtained under the consent lawful basis, therefore you are free to decline to provide that information.
Information on vaccination status will be held in a password protected file, accessible only to those who handle the contact tracing processes.
For more information, please see the updated Covid 19 Privacy Notice published on our Spotlight action page.
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First Name: *
Surname: *
I am based at: *
I have received my: *
I received this vaccination on (DD/MM/YY): *
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