Recording the Result of a Covid Test 2020/21

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Please complete this form if your child has completed:

1. An LFD home test given from school to inform us of the result (Negative, Positive or Void). If void please repeat another test and form response.

or

2. An external PCR Test (ONLY if it is positive)

Email *

Name of student *

DOB of student *

YYYY

Student's year group *

Year 7

Year 8

Year 9

Year 10

Year 11

Year 12

Year 13

Which test was taken? *

LFD Home Test Kit from School

PCR (externally taken)- only report if positive

Date of test result

YYYY

What was the result of the test? *

Negative

Positive

Void (please repeat and re-submit another response)

Did the student have any symptoms? *

Yes

Date of onset of symptoms- leave blank if no symptoms

YYYY

Name of person submitting this information *

Relation to student *

Preferred contact number for a staff member to reach you on *

A copy of your responses will be emailed to the address you provided.

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