Staff COVID-19 Testing

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 [21/01/2021] and the attached Privacy Notice.

Yes
No

2. I consent to completing a nose and throat swab for lateral flow tests.

Yes
No

3. 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on the day of testing I do not wish to take part, then I understand I will not be made to do so and that consent can be withdrawn at any time ahead of the test.

Yes
No

4. I consent that I will be tested for the presence of COVID-19.

Yes
No

5. I will complete the home result reporting form after each test.

Yes
No

6. I understand that if my results are negative on the lateral flow test I will be able to come into school as normal.

Yes
No

7. If the lateral flow test indicates the presence of COVID-19, I commit to ensuring that I contact school as promptly as possible, bearing in mind I may have some anxiety following a positive test result.

Yes
No

8. I consent that I will need to self-isolate following a positive lateral flow test result, until the results of the confirmatory PCR have been received.

Yes
No

9. I agree that if my test results are confirmed to be positive from this PCR test, I will report this to the school and I understand that I will be required to self-isolate following public health advice.

Yes
No

Signature (full name needed)

Date of Birth

Date when you completed the form

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