• Further to recent Government guidance, we are in the process of preparing to return staff to work. As the first step in our safety measures to ensure we all return to work as safely as possible, we require you to complete this questionnaire prior to you attending work, to safeguard you and your colleagues from the continued risk posed by COVID-19. Please answer all the questions listed clearly by putting a X in either the ‘Yes’ or ‘No’ box. If you have answered ‘Yes’ to any of the questions, please provide more details in the comments section. Please also carefully read the declaration at the end of this form and print your name, sign and date to confirm that have read and agree with the statements.