COVID-19 Symptoms Checker

This checker is to self assess for symptoms of Covid-19 and to declare that you are fit and well in order to visit for your activity.

Our aim is to promote and maintain the health and safety of all participants and staff. Please help us by answering the questions about the participant honestly and accurately on the day of each visit.

Checker Update - In line with current UK Government guidance and user feedback, we have modified some of our checker questions. As guidance develops, we will continue to update the checker and you may notice new or different questions included.

Participant's details:

Symptoms

Is the participant experiencing any of the following symptoms:

A fever/high temperature (Above 37.8°C) YES NO

A new, continuous dry cough? YES NO

A loss or change to their sense of taste or smell? YES NO

Isolation / Restrictions

Is the participant isolating as a precaution due to living in the same household as someone with Covid-19 symptoms, or with someone who has tested positive for Covid-19? YES NO

Is the participant isolating as a precaution whilst awaiting the results of a PCR test having been identified as a "close contact” with a person who has tested positive for Covid-19 (Including those notified by NHS Test & Trace)? YES NO

Is the participant confirmed as having Coronavirus and required to isolate? YES NO

Has the participant been asked to isolate by another organisation - e.g. School or Employer? YES NO

Is the participant prevented from attending as a result of shielding? YES NO

Is the participant currently required to isolate or quarantine following overseas travel? YES NO

Consent

This consent should be given by the participant or an adult/guardian. If under the age of 13 consent must by given by whoever holds parental responsibility for the child.

I understand that the submission of this information is voluntary and I consent for all of the information provided to be shared with and viewed by my organisation (including it’s staff), and being stored by Proactive Reporting for the sole purpose of providing the Covid-19 Symptom Checker service, and I understand how my data will be used. Full details here YES NO

Special Category Data – Health (Symptoms of Covid-19 & Confirmation/Possibility of infection)

I understand that the submission of this information is voluntary and I consent for all of the information to be shared with and viewed by my organisation (including it’s staff), in order for my organisation to advise me (electronically) on whether the participant named should or should not attend and participate in activities. Full details here YES NO

I can confirm that I have answered all questions honestly and that the information given is correct. YES NO

You must confirm you have answered all questions honestly before the form can be sent.

What happens next...

If you have answered "NO" to all questions you are safe to attend your session. You will receive an email confirming this and your organisation will have a record.

If you have answered "YES" to any of the questions your organisation has asked that for the safety of staff and other participants you don't attend at this time.

Please complete the checker before every visit.

For further guidance and information please visit the relevant government guidance site (e.g. gov.uk/coronavirus) or your governing bodies return to play information.