Working Friends Visitor Form – Scargill Movement

Working Friends Visitor Form
COVID-19 Information
Just a few pieces of information that will be helpful whilst you are with us:
- Please keep a face covering with you at all times. We need to wear a face covering when inside the building with other people, apart from when seated to eat or drink.
- In the dining room seating has been arranged for those distancing to be able to sit opposite another person and a member of community will serve you your meal – enjoy!
- Lounge seating has been arranged for a maximum of 6 people – Sun Lounge, Morning Room, Marsh Lounge.
- Community prayers are in the Chapel at 8:30am, 1:45pm & 4:30pm. Please have a chat with us when you're here if you would like to join us so we can make the appropriate arrangements.
- Please abide by the usual 2m distancing rule whenever possible.
- There are a number of hand sanitiser points around the building. We encourage their regular use throughout the day.
NHS Test & Trace*
We need to keep a record of visitors to Scargill to support the NHS Test and Trace programme.
For occasional visitors, in line with guidance issued by the Department for Health and Social Care, we keep these details for 21 days after a visit.
As you visit Scargill more regularly, we would like your consent to keep your details from this form safely and in compliance with GDPR legislation until the end of the NHS Test & Trace programme or until you let us know otherwise. This saves having to get this consent for each of your visits.
We will only share your details with NHS Test and Trace, if asked, in the event that it is needed to help stop the spread of COVID-19.
I agree to my data being used for NHS Test and Trace as described above
Name*
First name Surname
Contact email address*
Contact phone number*
Pre-Visit Declaration*
To help take care of each other, if any of the questions below are true on a day that you are due to visit as a Working Friend, please don't come and let us know that you won't be visiting.

1. Do you currently have, or have you experienced in the last 14 days, any COVID-19 symptoms, even if only mildly?
(new continuous cough, temperature above 37.5 degC or loss / change in normal sense of taste or smell)
2. Have you felt physically unwell with any other symptoms in the last 14 days?
3. Have you had any close contact with, or cared for, someone diagnosed with or suspected of having COVID-19 within the last 14 days?
4. Have you travelled back from a country on the UK Quarantine list in the past 14 days?
5. Have you been in close contact with anyone who has travelled back from a country on the UK Quarantine list within the last 14 days?
I agree not to come to Scargill if any of these questions are true on a day when I was due to visit
When you submit this form, you will also receive a copy by e-mail.