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Keyworker data collection
Please complete this form only if you are a keyworker as defined by the UK government (see below for qualifying roles). We will need this information by midday Friday so we can plan for partial opening from Monday 23 March 2020
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Email address
*
Your answer
Employment Details
Please provide the following details of your employment: Name of your employer, address, contact name; email address and telephone number of your line manager. PLEASE TAKE CARE TO PROVIDE ALL OF THIS INFORMATION
As main parent/carer/guardian, which of the following keyworker roles are you currently employed in?
*
NHS staff
Ambulance Service
Police Service, community support, civilian staff
Fire Service
School staff - primary/secondary
Staff at FE or Early Years/Nursery
Supermarket/food shop worker
Supermarket Delivery Driver
Pharmaceutical worker
Care Worker
Prison or Probation Service
Armed Forces Personnel
Environmental Health Officer
Social Workers
Local Authority Planners
Highway Agency Traffic Officers
Other:
Employer
*
Your answer
Address
*
Your answer
Contact name
*
Your answer
Email Address of line manager
*
Your answer
Contact number of line manager
*
Your answer
Details of children
Please fill in the details of all of your children and indicate if they should come into school or remain at home during this period.
Name of Child 1
*
Your answer
Year group
*
Choose
Nursery
Reception
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6
This child will need to come into school and be looked after
*
Yes
No
Name of Child 2
Your answer
Year group
Choose
Nursery
Reception
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6
This child will need to come into school and be looked after
Yes
No
Clear selection
Name of Child 3
Your answer
Year group
Choose
Nursery
Reception
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6
This child will need to come into school and be looked after
Yes
No
Clear selection
Name of Child 4
Your answer
Year group
Choose
Nursery
Reception
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6
This child will need to come into school and be looked after
Yes
No
Clear selection
Submit
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