Return to training – staff







    RETURN TO TRAINING DECLARATION – MANDATORY FORM FOR STAFF
    PLEASE COMPLETE AND CLICK SUBMIT

    All staff will be sent an email and video outlining the new protocols/risk assessments for either Spectrum or SSP, staff must have read /viewed the information before signing this form.

    Question Yes/No

    More Information
    1. Have you had confirmed Covid-19 infection or any symptoms (listed below) in keeping with Covid-19 in the last five months?
    • Fever
    • New, persistent, dry cough
    • Shortness of breath
    • Loss of taste or smell
    • Diarrhoea or vomiting
    • Muscle aches not related to sport/training


    YesNo

    If ‘Yes’, please provide details:
    If 7 days post recovery and no symptoms then a gradual return to exercise is permissible but should persistent symptoms of breathlessness on exertion then you should consult your usual medical practitioner.
    2. Have you had a known exposure to anyone with confirmed or suspected Covid-19 in the last two weeks? (e.g. close contact, household member)



    YesNo

    If ‘Yes’, please provide details:
    You will not be allowed to work until you have self-isolated for 14 days.
    3. Do you have any underlying medical conditions?
    (Examples include: chronic respiratory conditions including asthma; chronic heart, kidney, liver or neurological conditions; diabetes mellitus; a spleen or immune system condition; currently taking medicines that affect your immune system such as steroid tablets)



    YesNo

    If ‘Yes’, please provide details:
    If you have an underlying medical condition that makes you more susceptible to poor outcomes with COVID-19 (including age >65) then you should consider the increased risk and may want to discuss this with you usual medical practitioner

    4. Do you live with or will you knowingly come in to close contact with someone who is currently ‘shielding’ or otherwise medically vulnerable if you return to the training environment?



    YesNo

    If ‘Yes’, please provide details:
    This is an individual call but awareness of risks and the appropriate precautions should be taken.
    5. Do you fully understand the information presented in this Return to Training Mandatory Form and the email and video briefing and accept the risks associated with returning to the training environment in relation to the Covid-19 pandemic?



    YesNo

    If no please contact the Lead Covid Officers – gcsc.covid@gmail.com. Additional explanation required in this circumstance and if understanding is not forthcoming they should be advised not to work.


    If you have any other symptoms (no matter how mild) which may be connected to another virus or bacterial infection please allow 48 hours after symptoms have gone before returning to work in order to protect all swimmers and staff.

    SIGNATURE PAGE FOR STAFF:

    For staff under 18 – parents should complete the form above and tick the boxes below and sign:


    6. I understand that it is my responsibility to inform the Lead Covid Officers if my answers to any of the Health Questions change after I have submitted the form and that I should NOT attend work until I have permission from the Lead Covid Officers.

    YesNo

    7. I have checked that my mobile / emergency contact details are up to date on TeamUnify or if I do not have access to TeamUnify I have given them on this form:

    YesNo

    8. I have read the protocols and procedures and risk assessment and viewed the video sent by the Lead Covid Officers explaining the protocols that need to be followed on returning to work. (If you have any questions about the protocols please ensure that these are cleared up before signing this form):

    YesNo

    9. I understand I will be given by own bag of PPE. I also understand that at the time of writing face masks are not compulsory, but should I wish to wear a face mask during the sessions I may do so. I agree that should face masks become compulsory I will wear a face mask at work.

    YesNo

    10. I agree that if government, Swim England or any other relevant guidance changes I will adopt/follow that guidance as directed by Guildford City Swimming Club.

    YesNo

    11. I understand and agree that if in the view of the Lead Covid Officer I intentionally break any of the social distancing measures put in place to safeguard swimmers/staff I will be suspended and a review of my employment will take place.

    YesNo

    12. I confirm I am happy to return to work, but also agree that depending on the needs of the Club, I may continue to be furloughed or flexibly furloughed as necessary.

    YesNo



    Please note, if you have ticked YES to questions 1 – 4 or NO to questions 5 to 11 on this document you must not return to work until the Lead Covid Officers have cleared you for work.

    STAFF MEMBER’S FULL NAME*:

    STAFF MEMBER’S MOBILE NUMBER INCLUDING UNDER 18s*:

    STAFF MEMBER’S EMAIL ADDRESS*: Parent’s email address if under 18

    STAFF MEMBER’S ADDRESS*:

    SIGNED*: If under 18 Parent’s Signature is Required:

    DATE*:

    EMERGENCY BACK UP MOBILE FOR STAFF MEMBER*: If under 18 this should be a parent

    EMERGENCY CONTACT NAME*: Add relationship to staff member

    PARENT’S FULL NAME (if applicable):

    DATE:

    If you have any questions regarding this form etc please contact the Lead Covid Officer’s at gcsc.covid@gmail.com.

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