COVID Visit 2
To ensure that it is completely safe to visit Forget me not Care home during the coronavirus crisis we would ask that you read and sign the following disclaimer, which amounts to a “Visitor’s code”.
I consent to COVID-19 testing on the day of the visit date and understand that a POSITIVE will result in the visit being cancelled with immediate effect. (Date and time of visit to be confirmed via e-mail) *
I confirm I will be responsible for logging my test result on the Government website and consent to the results being forwarded to e-mail address info@forgetmenotburnham.co.uk to enable efficient communication of result. *
I confirm that at the time of my planned visit I have not been told to self-isolate on the grounds that I:
• have travelled to a high-risk area which on return it was required that I should immediately self-isolate and I am still within that period of self-isolation.
• have travelled to an area, where on return I was required to self-isolate if I developed any Covid-19 symptoms and I have developed those symptoms.
• have been in contact with someone who has had symptoms of Covid-19 and who was a known risk (e.g. because of the foregoing reasons) or has been confirmed as having Covid-19.
Have you felt unwell recently? *
Have you had a recent onset of a new continuous cough? *
Have you noticed a loss of, or change in, normal sense of taste or smell? *
Have you recently returned from an overseas visit and are you still in the quarantine period? *
Have you, in the last 14 days, had contact with anyone with COVID-19? *
I confirm I am not required (or have been told to) self isolate *
I consent to my temperature being taken before entering the home. Should my temperature be above 37.2c I understand that entry will be declined without notice. *
I confirm that I understand that contact is restricted to holding hands only and I must refrain from kissing and/or cuddling. *
I confirm that I will wear requested supplied Forget me not PPE throughout the visit. *
I confirm that I understand that I must remain in the visiting room allocated during the visit. *
I confirm that I understand I will not be able to use any toilet facilities and staff will be unable to offer any refreshments. *
I confirm that any gifts must be given to staff before the visit, to enable the items to be quarantined for safety for 72 hours. *
If you arrive by car you will be required to remain in your car for the Covid19 testing, if you arrive by other means of transport unfortunately you will have to sit outside for testing.
* Please note we will send an acknowledgement to this email address, please keep an eye on your junk and spam folders in case it is mis-directed
Preferred day and times (please give at least three choices) *