This checker is to self assess for symptoms of Covid-19 and to declare that you are fit and well in order to visit for your activity.
Our aim is to promote and maintain the health and safety of all participants and staff. Please help us by answering the questions about the participant honestly and accurately on the day of each visit.
This consent should be given by the participant or an adult/guardian. If under the age of 13 consent must by given by whoever holds parental responsibility for the child.
I understand that the submission of this information is voluntary and I consent for all of the information provided to be shared with and viewed by my organisation (including it’s staff), and being stored by Proactive Reporting for the sole purpose of providing the Covid-19 Symptom Checker service, and I understand how my data will be used. Full details here
Please confirm you understand how your data will be used.
Your organisation has signed up to use this form provided by Proactive Reporting, part of Activate Management Ltd (Registered address 17a Arden Business Centre, Arden Forest Industrial Park, Tything Road, Alcester, B49 6HW). This form is designed to help your organisation remain Covid-19 compliant and provide you with a safe environment to visit.
We will store the data collected for your organisation for a period up to 7 years or until we are instructed to remove it by your organisation. If you would like your information removed please contact your organisation and they will inform us.
We respect your trust and protect your privacy, and therefore will never sell or share your data with any third parties.
If you have any questions or are concerned about how your organisation is using your data then please contact us at firstname.lastname@example.org
I understand that the submission of this information is voluntary and I consent for all of the information to be shared with and viewed by my organisation (including it’s staff), in order for my organisation to advise me (electronically) on whether the participant named should or should not attend and participate in activities. Full details here
Please confirm you understand how your data will be shared / viewed.
Special Category Data – Health (Symptoms of Covid-19 & Confirmation/Possibility of infection)
Your organisation (identified at the top of your Covid-19 Symptom Checker) has signed up to the use of this form and system provided by Proactive Reporting, part of Activate Management Ltd (Registered address 17a Arden Business Centre, Arden Forest Industrial Park, Tything Road, Alcester, B49 6HW).
The information collected includes information included in the “Special categories of personal data” as specified within the ‘General Data Protection Regulation (GDPR)’. Including the request for information about symptoms of Covid-19 as well as information about confirmed diagnosis or the possibility of having a confirmed diagnosis of Covid-19.
As such your organisation requires a lawful basis under Article 6 of the GDPR and a separate condition for processing under Article 9.
In this instance the ‘lawful basis’ under Article 6 of GDPR is – Consent And In this instance the ‘separate condition’ for processing under Article 9 is – Explicit Consent
Purpose of processing – The processing of your personal data is designed to provide your organisation with information related to the suitability of individuals to attend organised activities or to visit certain facilities. The processing is designed to facilitate your organisations adherence to guidance provided by government and governing bodies in order for individuals to self-assess for symptoms and to identify any other reasons for not taking part in activities.
The completion of this form is completely voluntary and you do not have to complete it for your organisation. You may opt out of completing this form and provide your organisation with an alternative method of self-assessment. If you are opting out please do not submit this form, instead you should contact your organisation to identify an alternative method.
Your organisation may only use this information for the purposes of monitoring self-assessment, and in determining whether you should/should not attend activities or facilities, and in the event that they are required to provide information to outside organisations as a legal requirement (for example in the event of an insurance claim).
I can confirm that I have answered all questions honestly and that the information given is correct.
You must confirm you have answered all questions honestly before the form can be sent.
If you have answered "NO" to all questions you are safe to attend your session. You will receive an email confirming this and your organisation will have a record.
If you have answered "YES" to any of the questions your organisation has asked that for the safety of staff and other participants you don't attend at this time.
Please complete the checker before every visit.
For further guidance and information please visit the relevant government guidance site (e.g. gov.uk/coronavirus) or your governing bodies return to play information.
Confirm these hours?
Do you wish to declines these worked hours?