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COVID-19 Screening Tool
COVID-19 Screening Tool

COVID-19 Screening Tool

This confidential survey is part of Kisharon’s COVID-safe procedure for visitors.

We have updated our Covid screening tool in light of recent guidance, and will continue to require all visitors to have a Lateral Flow Test in the 24 hours preceding their visit and to complete the information on this screening tool no later than 2 hours before such visit, to ensure that visits can be organised to maintain everyone’s safety.

If you are unable to confirm all the health screening questions below, please call your service manager to discuss further.

If you experience problems uploading a photo of your negative Lateral Flow test at the end of this screening tool, please continue to submit the health screening questions and bring a photo of your test result to show staff on arrival.

    I confirm that I do not have any of the following symptoms: high temperature, persistent cough, loss of sense of taste or smell, or flu-like symptoms


    I confirm that I am not self-isolating in accordance with NHS Test and Trace OR UK Government guidelines (including quarantine after traveling to Amber list countries)

    I confirm that I am not currently awaiting the result of a COVID test

    I confirm that I have not had a positive COVID-19 test result within the last 10 days

    I confirm that I have taken a Lateral Flow Test within 24 hours of my visit and the result is negative (Please upload a photo of your Lateral Flow test result below)

    Note: If you are unable to upload a photo here, please bring a photo on your phone to show staff when you arrive.

     

    Privacy Policy:
    All details provided on this form will be kept confidential.
    The information you provide on this form will not be shared with third parties.

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