Non-residential Fellow and academic affiliates Covid-19 reporting form

Name

Telephone contact details

College email address

Time and date of onset of symptoms (where applicable)

Time and date of exposure to household member suspected to have Covid-19 (where applicable)

Time and date of exposure to close contact who has tested positive for Covid-19 (where applicable). Please see PHE definition of close contact below.

PHE definition of close contact

Have you booked a coronavirus test?

Do you require any support from the College?

Have you been working on site in the last week?

If so, who from the College have you been in close contact with? Please list their names. The College will need to contact them to inform them that they should self-isolate should your test result be positive. Please see PHE definition of close contact below.

PHE definition of close contact

If there is any additional information that you would like to add, please do so below

Please note that the information that you provide will go to the HR team, Senior Tutor email account and to Emma Manuel, Lead Clinical Nurse. In completing this form, you will provide personal data which the College will process in accordance with its data protection obligations and its Data Protection Policy. Please see the College website for our Data Protection Statement which contains further information about how we process your personal data.