Full Name:  

Site and location working at:  

Section 1

1) Are you self-isolating because you have Coronavirus (COVID-19) symptoms?  

1a) What symptoms do you have?  

1b) What date did your symptoms start?  

1c) Have you had a PCR test?  

1d) What was the result of the PCR test?  

1e) If inconclusive, have you booked another test?  

Section 2

2) Are you self-isolating because someone in your household has symptoms or has tested positive for Coronavirus (COVID-19)?  

2a) Has the person in your household tested positive for Coronavirus (COVID-19)?  

2b) When did their symptoms start or if they have no symptoms what was the date they had their test?  

2c) When have you been told you need to self-isolate until?  

Section 3

3) Have you been contacted by NHS Test & Trace and told to self-isolate?  

3a) Was this contact with regards to a person in your household?  

3b) When have NHS Test & Trace told you to self-isolate until?  

Section 4

4) Are you self-isolating because you have been advised by someone within Igloo or at the site your are working at to do so?  

4a) What was the name of the person that told you to self-isolate?  

4b) What is the reason you have been told to self-isolate for?  

4c) What date were you told to self-isolate from?  

If you are self-isolating because NHS Test and Trace have contacted you or because someone in your household has symptoms or has tested positive for Coronavirus (COVID-19), you must update Igloo should you develop symptoms and/or test positive for Coronavirus (COVID-19) as soon as possible.