LATERAL FLOW TEST RECORD
Staff Member Details
Name
*
First Name
Last Name
Email
*
example@example.com
Event Attending
Vaccination Details
Have you had your COVID Vaccination?
Yes - 1 Dose
Yes - 2 Dose
No
Lateral Flow Test Details
Lateral Flow Test Serial Number
Date and Time of Test Taken
*
-
Day
-
Month
Year
Date
Hour Minutes
Result of Test after 30 mins
Please Select
NEGATIVE
POSITIVE
Upload a photo of your completed Lateral Flow Test Here
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of
Declaration
I confirm that I have undertaken an Approved Lateral Flow Test at the time stated above.
Yes
I confirm that I waited 30mins before reading the result.
Yes
I confirm that all of the information on this form is correct.
Yes
Signature
Date and Time of Form Submitted
-
Day
-
Month
Year
Date
Hour Minutes
Submit
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