Covid-19 Incident Reporting Form

Covid-19 Incident Reporting Form

It is expected that the Club will assist with Contact-Tracing on any persons that were in contact with the infected individual within 48 hours of the symptoms arising. In some cases, the numbers of individuals that may potentially be infected could be significantly high that the club has to temporarily suspend all training and games for a period of 14 days in order to reduce the spread of Covid-19. We are all responsible for the reduction in spread of this virus and we ask clubs as integral parts of their communities, to be especially vigilant at this time to guard against any unnecessary suffering that this disease may cause. This info may be shared with Kingston University if a case is reported. General Data Protection Regulations 2018.
Covid-19 Officer Name *

First Name Last Name
Club Name *
Email *
example@example.com
Phone Number *

Phone Number
What incident type are you reporting? *

A member of the club has been diagnosed with Covid-19 I want to provide a Covid-19 related concern
How was the individual diagnosed? *

Club screening protocols Medical testing Self diagnosed Both
When did the diagnosis take place? *

Day Month Year
Date
How many club sessions did the individual attend within 48 hours of their diagnosis? *
How many games has the individual been a part of within the last 48 hours? *
How many players, coaches, support staff have potentially been in physical contact with the individual? *
Have you commenced with with contract tracing with players who may have come into contact with the infected individual? *

Yes No
Have you informed the infected individual to remain in isolation for 14 days as per Government guidance? *

Yes No
Please upload any applicable attendance registers from sessions including the infected individual

Browse Files

Cancel of
Please upload any applicable screening documentation

Browse Files

Cancel of
Please let us know any further information that will help assist you / your club in managing this Covid-19 related issue
Should be Empty: