COVID Test Form

Full Name

Email

Phone

Date of Birth

Event Name

Date of Test

Time of Test

Result
PositiveNegative

Tick to confirm you agree with the following statements
I understand that if my result is positive I will need to attend a further test through the national testing system and that the Test and Protect team will then take contact tracing and any other public health action based on the results of this test.
I understand that I must observe all prevention measures, such as facial covering, maintaining social distancing and using hand gel – both whilst attending my test, and after a result is obtained.
I understand that evidence of the test must be provided to Breathe, and admittance to the site will be prohibited if a positive test is received.

Sign by writing name below