LFT Results - Staff
This form is for the staff of Blessed William Howard to report their self administered Lateral Flow Test results.

Tests can only be conducted with consent.

By completing this form, you are confirming that you have read the privacy notice which can be found here: https://www.bwh.staffs.sch.uk/docs/Coronavirus/Covid_testing_privacy_statement_-_Jan_2021.pdf
Name *
Date *
MM
/
DD
/
YYYY
Time of Test *
Time
:
Test result *
If you have tested positive, please contact Mr Brown, Mrs Deakin or Mr Dudley in addition to completing this form.
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