Learning Disability Deaths 1 March 2020 onwards
This form is being used to collect information in relation to the deaths of learning disabled people in the UK during the Covid19 pandemic. You do not need to use the person's real name but I (@GeorgeJulian) do need your name and email address and you need to have the permission of their next of kin to share this information with me. If you need help completing this form please email LearningDisabilityCovid@gmail.com Thank you.
Sign in to Google to save your progress. Learn more
Your Name *
Email *
Name of the person who died (use a pseudonym if you prefer) *
What was their sex? *
What was their date of death? *
How old were they? (Leave blank if unknown) *
Where did they die? *
Whereabouts in the UK did the person usually live? Please supply the first half of the postcode. *
Was it suspected, or confirmed, that they had Covid19? *
Was their death referred to the coroner? *
Would you like their death to be added to an online memorial map showing the deaths of learning disabled people during this time? *
Anything else that you think we should know
Please confirm that you understand that we are collecting this information to remember the lives and deaths of learning disabled people during the Covid19 pandemic, and you are happy for us to hold this data and share publicly in the manner you have chosen above *
Please confirm that you have consulted with the deceased person's next of kin (if you are not them) and they are happy for you to share this information *
Are you happy for someone to contact you to collect more information about the person and the care that they received? *
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy