Covid Visitor Questionnaire

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This form must be completed every time you are enter Balcombe School - paper copies are available from the office

Name *

Date of visit *

YYYY

Reason in school: *

Have you recently returned from a holiday abroad? *

Yes - if it is from a listed "quarantine" country and is within the last 3 weeks, you should not be in school

Do you have any long time chronic illness *

Yes - it is not appropriate for you to be here at the current time

Are you showing (or have you recently shown) any symptoms of Covid-19? *

Yes - it is not appropriate for you to be here at the current time and you should seek to be be tested as soon as possible.

Do you live with someone showing symptoms of Covid-19? *

Yes - it is not appropriate for you to be here at the current time and you should organise for them to be tested as soon as possible.

Are you in the 'clinically extremely vulnerable' category? *

Yes - it is not appropriate for you to be here at the current time.

Are you in the 'clinically vulnerable' category? *

Yes - you may wish to consider if it is appropriate for you to be here at the current time.

Have you taken a Lateral Flow Test in the last 3 days? *

Yes

What was the result of the test? *

Negative

Positive

If you have answered NO to all of the above questions, we welcome you into our school. You MUST wear a face mask or visor at all times whilst in the building, use the gel/handwashing facilities available and minimise direct contact with pupils and staff *

Agree

Disagree

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