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COVID-19 Virus Self Certification Compliance
Your Details
Name
*
Temperature
*
I confirm I have no signed of illness, including but not limited to the Governments COVID-19 recognised symptoms
*
Select
I confirm I have no signs of illness, including but not limited to the Governments COVID-19 recognised symptoms
I don't feel well
I have one or more of the Governments COVID-19 recognised symptoms
COVID-19 Symptoms and/or Test for Members of my Househouse
*
Select
No one in my home has tested positive for COVID-19 in the past 14 days, or shows recognised signs of COVID-19 as defined by HM Government
Someone in my home has tested positive for COVID-19 or shows recognised signs of COVID-19 as defined by HM Government
Face Protection
*
Select
I confirm I will wear a face mask whenever within 2 metres of a client or member of the team
I will not be come in to contact with other team members or clients
Hygeine
*
Select
I confirm I will sanitise my hands regularly and after any contact with a object or area not my own
I will not be using any company equipment or areas
Additional Notes (if required)
Today I confirm
*
Select
I am compliant, fit and healthy for work
I am unable to work due to illness or an officially recognised reason
Self-Test Kits are now available on request from the office so if you have any symptoms or just feel unsure about your COVID-19 status, you can get it checked instantly
We can also arrange for Home Delivery of the Self-Test Kits if necessary
Online COVID-19 Resources
Welsh Government Coronavirus Guidelines
Welsh Government Test, Trace, Protect
Please check-in each day of work,
including remote work
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