COVID-19 Symptoms Checker - Berkshire Hockey Association

The purpose of 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.

Participant's details:


Today or at any point in the last 14 days has the participant had:

A fever/high temperature (Above 37.8°C)
A new, continuous dry cough?
A loss or change to their sense of taste or smell?
Abnormal fatigue or drowsiness?
Difficulty breathing or shortness of breath?
Chest pain or tightness?
Sore throat or hoarse voice?
Abdominal pain, vomiting or diarrhoea?
Confusion or disorientation including loss of speech or movement?
Headaches?
Different joint or muscle pain?
New rashes, or discolouration of fingers or toes?
Conjunctivitis?
Has the participant been in contact with anyone showing symptoms of Coronavirus, or who has received a positive Coronavirus test in the last 14 days?
Is the participant currently isolating as a result of showing symptoms of Coronavirus?
Is the participant confirmed as having Coronavirus?
Has the participant been asked to isolate by the UK Government Track and Trace service?
Is the participant living with someone who is currently required to shield?
Is the participant prevented from attending by local or regional lockdown restrictions?
Is the participant currently required to isolate or quarantine following overseas travel?

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

Please confirm you understand how your data will be used.


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

Please confirm you understand how your data will be shared / viewed.


I can confirm that I have answered all questions honestly and that the information given is correct.

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.