COVID-19 Reporting Form Lydian Care Carer COVID Reporting Form MANAGERS 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 AM PM AM/PM Carers Name:(Required) First Last Has the carer received both vaccines?(Required) Yes No If yes when did they receive their second vaccine? if no please ask why:(Required)Has the carer recieved their booster?(Required) Yes No N/A Date 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 Belfast Healthcare - Which area(Required) SE Trust Southern Trust Belfast Trust Northern Trust Western Trust Private Area Carer Works For Carol:(Required) Downpatrick Crossgar Killyleagh Saintfield Ballygowan Comber Ballynahinch Reason 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 Other Name & 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 AM PM AM/PM Action 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 times Select All
