Who is this for?
Who do you work for?
Employer

Which service provider?

Which healthcare provider?

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Self-declaration

This is a statement made by you to confirm your current health status.
Find out more

Do you have a high temperature (38℃ or above)?
Do you have a new, continuous cough?
Do you have any difficulty breathing?
Have you had a recent loss or change to your sense of smell or taste?

i Choose ‘yes’ for any of the above symptoms you’re currently taking medication for (e.g. Paracetamol for a high temperature)

In the past 14 days have you been in close contact with anyone who has, or thinks they have, COVID-19?
In the past 14 days have you visited a country that required you to self-isolate on arrival, or on your return to the UK?
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