Return to Workplace - 8th March 2021 - (copy)

Staff questionnaire following full opening of school - 8th March 2021
Name: 


A red asterisk (*) indicates required questions.

  1. Do you have any underlying health conditions or other characteristics that put you at greater risk of serious illness if you contract COVID-19?

    A list of conditions and characteristics that may put you in the moderate risk (clinically vulnerable) or high risk (clinically extremely vulnerable) categories is available at NHS.UK. *
    Yes
    No


  1. If you answered yes to question 1 please specify if you fall into the clinically vulnerable category or clinically extremely vulnerable category.

    Medical evidence should be submitted to Louise Green, either in person or via email.
    You will be contacted by a member of SLT following receipt of this.


  1. Is anyone in your household in the high risk (clinically extremely vulnerable) category? *
    Yes
    No


  1. Have you been advised against attending the workplace by a medical professional?*
    Yes
    No


  1. Do you, or any members of your household, currently have or have recently had (in the last 4 weeks), symptoms that may be caused by COVID-19?*
    Yes
    No


  1. Have you recently (in the last 2 weeks) been contacted by NHS Test & Trace and advised to self-isolate?*
    Yes
    No


  1. Have you recently (in the last 2 weeks) visited a country that requires a 14-day self-isolation on return to the UK? *
    Yes
    No


  1. Do you believe that returning to the workplace, or visiting third party premises for work would cause you high levels of fear or anxiety?*
    Yes
    No


  1. If you have answered yes to question 8 please provide details of specific concerns you may have. These may be certain areas of the school or related to specific tasks.


  1. Are you able to commute into the workplace without needing to use public transport? *
    Yes
    No


  1. Are you allergic to any type of cleaning or disinfectant product? *
    Yes
    No


  1. If you answered yes to question 11 please provide more details.


  1. Are you allergic to any soap or hand sanitiser products?
    *
    Yes
    No


  1. If you replied yes to question 13 please provide more details.


  1. Please provide any additional relevant comments or concerns.





OSH