Consent form for 6th form for COVID-19 testing in secondary schools
This is a Government-issued form to be completed by a student who is over 16, having discussed participation with their parent/guardian, to give consent to participate in school-based tests designed to detect asymptomatic coronavirus cases.
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Terms of Consent
1) I have had the opportunity to consider the information provided by the school about the testing, ask questions and have had these answered satisfactorily, based on the information presented in the letter dated 20/08/2021 and the privacy notice attached below.
 2) In the case of under 16s, I have discussed the testing with my child and my child is happy to participate. If on the day of testing they do not wish to take part, then they will not be made to do so and consent can be withdrawn at any time ahead of the test.
3) I consent to having a nose and throat swab for lateral flow tests.  I will self-swab if I am able to.  Otherwise I understand that assistance is available.
4) I understand that there may be multiple tests required and this consent covers all tests for the below named person. If, on the day of testing I  do not wish to take part, then I understand I will not be made to do so and that consent can be withdrawn at any time ahead of the test.
5) I consent that my sample(s) will be tested for the presence of COVID-19.
6) I understand that if my results are negative on the lateral flow test I will not be contacted by the school except when they are a close contact of a confirmed positive.
7) If the lateral flow test indicates the presence of COVID-19, I commit to ensuring that I will be removed from school premises as promptly as possible, bearing in mind I may have some anxiety following a positive test result.
8) I understand that I will need to self-isolate following a positive lateral flow test result.
9) I understand that if my test results are confirmed to be positive from this lateral flow test, I will be required to self-isolate following public health advice.
10) I understand that if a close contact of mine tests positive, that I will self-isolate for 10 days in line with Government guidance.


Personal Information and Consent
First name
Last name
Year Group
Clear selection
Date of birth
MM
/
DD
/
YYYY
Gender - this information is needed for Department for Health and Social Care research purposes
Clear selection
Ethnicity-this information is needed for Department for Health and Social Care research purposes
Clear selection
Currently showing any COVID-19 symptoms?
Clear selection
Home postcode
Signature (typing out your name digitally is sufficient as you are filling in this form digitally)
Today's date
MM
/
DD
/
YYYY
Details of any health or accessibility issues which might affect my safe participation in the testing exercise.
Privacy Notice
Ownership of the Personal Data
To enable the Covid-19 testing to be completed at Holly Lodge Girls’ College, we need to process personal data, including the sharing of personal data where this is allowed under data protection legislation. Holly Lodge Girls’ College is the Data Controller for the data required for the management of tests and implementing local arrangements in the event of a positive test and undertaking any actions needed by school as part of the school’s health (including public health), welfare and safeguarding role and obligations.
Personal data relating to tests for pupils is processed under article 6 (1) (e) of the UK GDPR (public task). This is based on the school’s proprietor’s official authority for the conduct of the school. [Section 175 of the Education Act 2002 and paragraph 3 of Schedule 1 to the Education Act 2002 for maintained schools is also relevant.  
We will process special category personal data under the provisions of article 9.2(i) of the UK GDPR, and Part 1 of Schedule 1(3) of DPA 2018 where it is in the public interest on Public Health Grounds to ensure we can minimise the spread of COVID in a timely manner and enable us to continue to deliver education services as safely and securely as possible. This data is processed under the obligations set out in Public Health legislation (Regulations 3(1) and (4) of the Health Service (Control of Patient Information) Regulations 2002 (COPI)) which allows the sharing of data for COVID related purposes and where it is carried out by a health care professional OR someone who owes an equivalent duty of confidentiality to that data.
Ownership of the Personal Data you share with DHSC
Every time you use a lateral flow test you must report the results. More details can be found here - Report a COVID-19 test result - GOV.UK (www.gov.uk). The Department for Health and Social Care (DHSC) is the data controller for the information that you transfer to them about you and your test results. For more information about what the DHSC do with your data please see their COVID-19 Privacy Notice
The school remains the Data Controller for the data we retain about you for the management of tests and implementing local arrangements in the event of a positive test.
You should read both this Privacy Notice and the DHSC COVID-19 Privacy Notice to understand how your personal data is used prior to taking a test.


Personal Data involved
The following personal data is processed by the school in relation to your test:
Name
Unique code assigned to each individual test and which will become the primary reference number for the tests.
Test result
For more information about what the DHSC do with your data please see their COVID-19 Privacy Notice
How we store your personal information
The school will maintain a test kit log which will record against your name details of the testing kit which has been provided to you. The school may also record Personal Data about you in its internal COVID-19 test register (the school’s COVID-19 test register will not be shared with DHSC). This information will only be stored securely on locally managed systems with appropriate access controls in schools and will only be accessible to personnel involved in the management of tests and implementing local arrangements in the event of a positive test.  
The school will retain its test kit log and COVID-19 test register for a period of twelve (12) months from the date of the last entries made by the [school/college] into them.
For more information about what the DHSC do with your data please see their COVID-19 Privacy Notice
Processing of Personal Data Relating to Positive test results
We will use this information to enact our own COVID isolation and control processes without telling anyone who it is that has received the positive test.
For more information about what the DHSC do with your data please see their COVID-19 Privacy Notice
This information will be kept by the school for a period of twelve (12) months and by the NHS for eight (8) years.
Processing of Personal Data Relating to Negative and Void test results
We will record a negative and void result for the purpose of stock controls of tests and general performance of the testing process.
Data Sharing Partners
The personal data associated with test results will be shared with
DHSC, NHS, PHE – to ensure that they can undertake the necessary Test and Trace activities and to conduct research and compile statistical information about Coronavirus.
Your GP – the NHS may share the information you provide with your GP to maintain your medical records and to offer support and guidance as necessary. Any data you provide to the school will not be shared with your GP.
Local Government to undertake local public health duties and to record and analyse local spreads.
Personal Data in the school’s test kit log will be shared with DHSC to identify which test kit has been given to which individual in the event of a product recall. The school will not share its internal COVID-19 test register with DHSC.
Your Rights
Under data protection law, you have rights including:
Your right of access - You have the right to ask us for copies of your personal information.
Your right to rectification - You have the right to ask us to rectify personal information you think is inaccurate. You also have the right to ask us to complete information you think is incomplete.
Your right to erasure - You have the right to ask us to erase your personal information in certain circumstances.
Your right to restriction of processing - You have the right to ask us to restrict the processing of your personal information in certain circumstances.
Your right to object to processing - You have the the right to object to the processing of your personal information in certain circumstances.
Your right to data portability - You have the right to ask that we transfer the personal information you gave us to another organisation, or to you, in certain circumstances.
You are not required to pay any charge for exercising your rights. If you make a request, we have one month to respond to you.
Please contact us at HollyLodge@hollylodge.liverpool.sch.uk if you wish to make a request.
How to complain
If you have any concerns about our use of your personal information, you can make a complaint to us by email to hollylodge@hollylodge.liverpool.sch.uk
You can also complain to the ICO if you are unhappy with how we have used your data.
The ICO’s address:          
Information Commissioner’s Office
Wycliffe House
Water Lane
Wilmslow
Cheshire
SK9 5AF

Helpline number: 0303 123 1113




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