COVID-19 STAFF TESTING
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Mandatory fields
*First name
First name is required
*Last name
Last name is required
*Email Address
Email Address is invalid/required
NHS Employee Number
*Dept. or Ward
Dept. or Ward is required
*Job Role
Job Role is required
*Date of Birth
Date of Birth is required
*Telephone No.
Contact Telephone No. is invalid/required
*Home Postcode
Home Postcode is invalid/required
*Lot Number on Test Box
Test Strip Lot Number is required
*Date of Test
Date of Test is required
*Time of Test
Time of Test is required
*Test Result
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Positive
Invalid
If Invalid, check this to confirm that repeat test has been performed and the result submitted.
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