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. Book a Test Name *Email Address *Date of Last Rowing Session *Time of Last Session (24hr clock) *Hours-000102030405060708091011121314151617181920212223Minutes-000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859Name of SessionHave You Had a Test? *Please select an optionYes - Positive ResultYes - Awaiting ResultNo - Test BookedNo - Test NOT BookedPlease tick the following statements which are TRUE *I have symptoms of COVID-19I 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 isolateAdditional InformationAdditional Comments or Requirements0 / 180Send MessagePlease do not fill in this field.