Contact Tracing Form
Please answer yes or no to the questions below
*
Rows
Yes
No
Do you have symptoms of cough, fever, high temperature, sore throat, runny nose, breathlessness or flu like symptoms now or in the past 14 days?
Have you been diagnosed with confirmed or suspected COVID-19 infection in the last 14 days?
Are you a close contact of a person who is a confirmed or suspected case of COVID-19 in the past 14 days (i.e. less than 2m for more than 15 minutes accumulative in 1 day)
Are you awaiting results of a Covid-19 test?
Have you been advised by a doctor to self-isolate at this time?
Have you been advised by a doctor to cocoon at this time?
Have you been advised by your doctor that you are in an at risk group?
Name of Event
*
Date of Event
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Attendee name
*
First Name
Last Name
Attendee Email
*
example@example.com
Attendee Phone Number
*
-
Area Code
Phone Number
Who is the Event Organiser
*
Club, if applicable
Submit
Should be Empty: