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Covid Reporting Form
Please complete for your recent positive covid 19 result
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* Indicates required question
Name (Surname, Forename)
*
Your answer
Year Group (If pupil)
Your answer
Date Symptoms Started (if relevant)
MM
/
DD
/
YYYY
Date of Positive Lateral Flow (if relevant)
MM
/
DD
/
YYYY
Date PCR Taken
*
MM
/
DD
/
YYYY
Date received Positive PCR result
*
MM
/
DD
/
YYYY
Date last in school prior to positive PCR result
*
MM
/
DD
/
YYYY
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