COVID-19 Reporting FormLydian CareCarer COVID Reporting FormMANAGERS MUST COMPLETE THIS FORM FOR EVERY CARER WHO REPORTS SYMPTOM OF COVID – 19 IN CONJUNCTION WITH THE FLOW CHARTS AND RISK ASSESSMENT TOOLS IN THE COVID-19 ASSESSMENT PACK.Date Report Made:(Required) DD dash MM dash YYYY Time Report Made: Hours: Minutes AMPM AM/PMCarers Name:(Required) First Last Has the carer received both vaccines?(Required) Yes NoIf yes when did they receive their second vaccine? if no please ask why:(Required)Has the carer recieved their booster?(Required) Yes No N/ADate Booster Received: MM slash DD slash YYYY Manager Completing Reporting Form:(Required)Carol SavageRachel DeeryLinda SpenceFiona KaneKerry O'RourkeDean FosterNicola McCaughertyArea Carer Works:Area Carer Works for Rachel:(Required) Newcastle Castlewellan Seaforde/Loughinisland Drumaness BelfastHealthcare - Which area(Required) SE Trust Southern Trust Belfast Trust Northern Trust Western Trust PrivateArea Carer Works For Carol:(Required) Downpatrick Crossgar Killyleagh Saintfield Ballygowan Comber BallynahinchReason for Reporting:(Required) Carer has symptoms Close contact has symptoms Member of their household has symptoms Been contacted by Track & Trace Carer has tested positive close contact has tested positive OtherName & Relationship of Contact with Symptoms or Positive Result:Symptoms as described (if applicable)(Required)Date symptoms began: MM slash DD slash YYYY Date of positive result: MM slash DD slash YYYY Time Hours: Minutes AMPM AM/PMAction Taken: detail actions including if and when a test is arranged, vaccination status for next steps, LFT's available for day 6 & 7 etc..(Required)This form will be submitted to HR & the Registered Manager and a copy will also be emailed to you.Confirm you have checked the following:(Required) I have confirmed the reason for the report If carer has symptoms I have detailed them I have checked carer has been wearing full PPE at all timesSelect All
