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:* DD dash MM dash YYYY Time Report Made: : Hours Minutes AM PM Carers Name:* First Last Has the carer received both vaccines?* Yes No If yes when did they receive their second vaccine? if no please ask why:*Has the carer recieved their booster?* Yes No N/A Date Booster Received: MM slash DD slash YYYY Manager Completing Reporting Form:*Carol SavageRachel DeeryLinda SpenceFiona KaneKerry O'RourkeDean FosterNicola McCaughertyArea Carer Works: Area Carer Works for Rachel:* Newcastle Castlewellan Seaforde/Loughinisland Drumaness Belfast Healthcare - Which area* SE Trust Southern Trust Belfast Trust Northern Trust Western Trust Private Area Carer Works For Carol:* Downpatrick Crossgar Killyleagh Saintfield Ballygowan Comber Ballynahinch Reason for Reporting:* 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 Name & Relationship of Contact with Symptoms or Positive Result: Symptoms as described (if applicable)*Date symptoms began: MM slash DD slash YYYY Date of positive result: MM slash DD slash YYYY Time : Hours Minutes 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..*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:* Select All 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
