Staff Shift Questionnaire
Please enter your full name
Which location are you based in?
Shift Date & Start Time
Since your last day at work, have you, or any member of your household, developed the symptoms of Covid-19 or felt in any other way unwell?
Have you recently been in contact with anyone who has exhibited any symptoms of Covid-19?
Have you recently been in contact with anyone who has tested positive for Covid-19?
As you answered YES to any of the previous questions, you should return home immediately!
Do you have any questions or would you like to provide any feedback?
Should be Empty: