1. First Name
2. Last Name
3. Record Temperature
°C
4. Confirm double vaccinated (please check vaccination card)
YesNo
5. Do you have any COVID-19 symptoms? (cough, sore throat, fever, headache, diarrhoea, loss of smell)
If yes, please call Healthline on 0800 358 5453
6. Have you been to any areas of interest at the relevant times in the last 5 days?
7. Have you been identified as a contact by the contact tracing team?
8. Have you or anyone living in your household been in contact with anyone that is COVID-19 positive or waiting for a test result due to being a casual contact?
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