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Staff Covid-19 reporting form

Staff should use this form to tell 51³Ô¹ÏÍøºÚÁÏ if they have Covid-19 symptoms or a positive test result.

Primary page content

The form is only for members of 51³Ô¹ÏÍøºÚÁÏ staff.

There is a different form for students.

This form will send your details to your line manager, department/service management and our Estates team.

We will use this information to make provisions for you and to help protect our community from Covid-19.

If you have any problems with this form email healthandsafety@gold.ac.uk.

* Department or Service
Start from 48 hours before your symptoms started and go up to when you began self-isolation. Include dates and times. Enter "I have not been on campus" if you have not been on campus.
* When did your symptoms first start?
* When did you start self-isolation?
* Have you had a Covid-19 test?
* What is the result of your Covid-19 test?
If you've had a test, what date did you have it on?

Data protection and confidentiality

Read our privacy notice on how we will use this information. Where necessary 51³Ô¹ÏÍøºÚÁÏ will share this information with the NHS Test and Trace and 51³Ô¹ÏÍøºÚÁÏ' accommodation providers in order to prevent and manage outbreaks of Covid-19.