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Physiotherapy
Paediatric Physiotherapy
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Oncology Physiotherapy
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Locations
Oxford
Summertown
Iffley Road
Bicester
Woodstock
Contact
Follow us
About
FAQs
Join Us
News
Meet the Team
Prices
Services
Physiotherapy
Paediatric Physiotherapy
ONLINE Appointments
Sports Injury Treatment
Hand Clinic
Pelvic Health Clinic
Oncology Physiotherapy
Sports Massage
Gait Assessment
Online & Studio Group Classes
Class Schedule
Locations
Oxford
Summertown
Iffley Road
Bicester
Woodstock
Contact
01865 311686
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To be completed by all clinical staff and instructors
COVID-19 Fit for Work Questionnaire
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First Name(s)
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Telephone Number
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Email
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Screening Questions
Do you have any of the following symptoms which are new or worsened if associated with allergies, chronic or pre-existing conditions: fever, cough, shortness of breath, difficulty breathing, sore throat, and/or runny nose?
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No
Yes
Have you returned to UK from outside the country in the past 14 days?
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No
Yes
In the past 14 days, at work or elsewhere, while not wearing appropriate personal protective equipment, did you have close contact with someone who has a probable or confirmed case of COVID19?
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No
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In the past 14 days, at work or elsewhere, while not wearing appropriate personal protective equipment, did you have close contact with a person who had acute respiratory illness that started within 14 days of their close contact to someone with a probable or confirmed case of COVID-19?
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No
Yes
In the past 14 days, at work or elsewhere, while not wearing appropriate personal protective equipment, did you have close contact with a person who had acute respiratory illness who returned from travel outside of UK in the 14 days before they became sick?
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No
Yes
I confirm I am aware of how to don and doff PPE, how to observe social distancing where appropriate and feel confident in my ability to minimise the spread of COVID-19 and adhere to all published guidelines and tops:health risk assessment procedures
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No
Yes
I can confirm I will follow tops:health policies and procedures in relation to COVID-19, including documentation, use of PPE, cleaning, adhering to social distancing, communication with clients and general team working to provide a consistently safe and professional environment
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No
Yes
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