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:* Date Format: DD dash MM dash YYYY Time Report Made: : HH MM AM PM Carers Name:* First Last Has the carer recieved the vaccine?*YesNoIf yes - have they received 1 or both? if no please ask why:*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 SymptomsClose contact has symptomsMember of their household has symptomsBeen contacted by Track & TraceName & Relationship of Contact with Symptoms:Symptoms as described (if applicable)*Date symptoms began: Date Format: MM slash DD slash YYYY Time : HH MM AM PM Action Taken: detail actions including if and when a test is arranged*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
