Report A Confirmed Case of Covid

Please use the form below.

What are you notifying us of?*
The person this COVID-19 report relates to*
Please give details*
Name of person this COVID-19 report relates to*
First Last
Name of person completing this report*
First Last
Email Address of person completing this report*
Phone Number of person completing this report*
Date of Confirmed POSITIVE COVID-19 Test Result*
DD slash MM slash YYYY
Date of Confirmed NEGATIVE COVID-19 Test Result*
DD slash MM slash YYYY
IMPORTANT - Please upload below, a photograph or screen-grab of the result.
You can upload multiple images/screen-grabs if necessary.
Drop files here or

Max. file size: 200 MB.
You can upload multiple images/screen-grabs if necessary.
Is someone displaying symptoms within your household?*
When did the symptoms start?*
DD slash MM slash YYYY
Has a COVID-19 test been booked for the person presenting with symptoms?*
The NHS advise: If you have any of the main symptoms of coronavirus (COVID-19), get a test as soon as possible. Stay at home until you get the result.
Main symptoms
The main symptoms of coronavirus are:
- a high temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature)
- a new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
- a loss or change to your sense of smell or taste – this means you've noticed you cannot smell or taste anything, or things smell or taste different to normal
Most people with coronavirus have at least 1 of these symptoms.
What to do if you have symptoms
If you have any of the main symptoms of coronavirus:
1. Get a test to check if you have coronavirus as soon as possible.
2. You and anyone you live with should stay at home and not have visitors until you get your test result – only leave your home to have a test.
Anyone in your support bubble should also stay at home if you have been in close contact with them since your symptoms started or during the 48 hours before they started.
Get a test to check if you have coronavirus on GOV.UK
When has the test been booked for?*
DD slash MM slash YYYY
Please provide any other relevant information
Please see here for information on self-isolation and treatment from the NHS.
Name
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Report A Confirmed Case of Covid

Main symptoms

What to do if you have symptoms