COVID Incident Form

    For swimmers who have been told to isolate, or have suspected or confirmed Covid, or have family members with suspected or confirmed Covid, please complete this form.even if you have been double vaccinated.
    ISOLATION MEANS YOU DO NOT LEAVE HOME FOR ANY REASON, OTHER THAN TO TAKE A PCR TEST home-guidance/stay-at-home-guidance-for-households-with- possible-coronavirus-covid-19-infection#samehousehold

    1. Details of swimmer affected as stated above

    a) First Name (mandatory)

    b) Last Name (mandatory)

    c) Squad (mandatory)

    d) Squad Coach (mandatory)

    e) Mobile contact number (mandatory) For swimmers under 18 this must be a parent’s mobile number:

    f) Email address(mandatory) For swimmers under 18 this must be a parent’s email address:

    g) For swimmers under 18 Parent’s name:

    1a. Other family members who are swimmers. Please give name and squad of all family members in box below. If necessary, they should complete a separate form.

    2. Swimmer told to isolate?

    If a swimmer been told to Isolate and they have already had 2 vaccinations, please complete the questions below and note 2c to 2e?

    2a. Please give the dates of the vaccines below:
    First Vaccine
    • Date of first Vaccine: …………………………………………………………………
    Second Vaccine
    • Date of Second Vaccine: …………………………………………………………..
    2b. Those who are double vaccinated and also under 18 and 6 months, identified as close contacts of positive coronavirus (COVID-19) cases are advised to get a free polymerase chain reaction (PCR) test as soon as possible. Provided they have not had a positive PCR test in the last 90 days.

    2c. A PCR home test can be ordered online or by calling 119, or going to a test site.
    2d. Anyone who tests positive following the PCR test will still be legally required to self-isolate, irrespective of their vaccination status or age in order to break onward chains of transmission.

    3. If swimmer has been contacted/notified to isolate who has not been double vaccinated or under 18 years and 6 months, please state who has contacted you:

    a) Track and Trace
    b) School
    c) College
    d) Uni
    e) Work
    f) Other

    3. Please State which of the above has notified you?


    3. Date told to start Isolating by Track and Trace or School/College/Uni etc SEE ASTERISK SECTION BELOW*


    3. If School/College/Uni please give date Covid case was last at School/College/Uni etc:


    3. Date Isolation expected to end? Please be aware that the isolation period is 10 days from the last point of contact with Covid positive person.


    3e. Do you lift share with any other members, if so, please give details of names and squads in the box below:

    4. Swimmer with suspected Covid Symptoms – Please follow advice on NHS Website

    4a. Please state date of suspected symptoms

    4b. Please state date of Covid Test

    4c. Please state Isolation start date

    4d. Please state isolation end date, allowing at least 10 days from beginning of symptoms

    5. Do you lift share with any other members, if so please give details of names and squads in the box below:

    6. Swimmer Tested positive with Covid – Please follow advice on NHS Website

    Please state date of positive test


    Please state date Isolation expected to end, please allow at least 10 days from positive test date


    Please state the date the swimmer last trained


    6d Do you lift share with any other members, if so please give details of names and squads in the box below:

    7. When do you NOT need to self-isolate.
    7a. If someone you live with has symptoms of Covid 19 or tested positive for Covid 19 you will not need to self-isolate if any of the following apply:
    • You are fully vaccinated and this means 14 days have passed since your final dose of vaccine
    • You are under 18 years and 6 months old
    • You are taking part or have taken part in a Covid 19 vaccine trial.
    • You are not able to get vaccinated for medical reasons (which should already be known to the Club)

    7b. Even if you do not have symptoms, you should still: Get a PCR test to check if you have Covid
    Follow advice on how to avoid catching and spreading Covid Consider limiting contact with people who are higher risk from Covid.

    8. The Covid Officers will check the form and will reply by email and confirm the date the swimmer will be able to return to swimming. Should we need any further information we will contact swimmer/parent by mobile.
    NOTE: As always, our priority is the safety of our members and staff, we will continue to monitor the situation regarding Covid and the effect on the Club.

    This is part of our risk assessment and is therefore mandatory for all members.

    If you have any questions regarding this form etc please contact the Lead Covid Officer’s at

    Please prove you are human