COVID-19 TRACK & TRACE

Please complete the form below to inform the committee of your current situation with regards to COVID-19.

In return the committee will endeavour to supply you / the NHS with a list of members that could be at risk.

Name *

Email Address *

Date of Last Rowing Session *

Time of Last Session (24hr clock) *

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Name of Session

Have You Had a Test? *Please select an optionYes - Positive ResultYes - Awaiting ResultNo - Test BookedNo - Test NOT Booked

Please tick the following statements which are TRUE *

I have symptoms of COVID-19 I have tested positive for COVID-19I have been contacted by NHS Track & TraceI live with someone who has symptoms or tested positiveSomeone in my support bubble has symptoms or tested positiveI have returned from a country / region with a high coronavirus riskIf you have ticked any of these you MUST self isolate

Additional InformationAdditional Comments or Requirements0 / 180

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