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Reporting an LFD home test result
Please complete the following form for each test carried out.
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* Indicates required question
Name of person tested (Pupil / Staff member)
*
Your answer
Date test taken
*
MM
/
DD
/
YYYY
Test result
*
Negative
Positive
Void
Reference/Log number on the test kit
*
Your answer
If reporting for a pupil, name of person reporting
Your answer
Relationship to pupil
Your answer
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