COVID-19 Health Declaration
As businesses begin planning for a return to work and production activities start, they will have engaged in a risk assessment process, looking at possible control measures for specific tasks, travel and adopting current government guidance and requirements.
Part of the return to work process will involve obtaining a health declaration for staff, or third parties that may be visiting site (site visits are restricted). This declaration seeks to confirm employees/sit visitors, or anyone in their household are not showing any symptoms of COVID-19 before they are permitted on site.
ABOUT THE DECLARATION
This declaration will outline key symptoms of COVID-19 and ask you to confirm you are not showing any of these, nor anyone in your household. In addition, if you are classed as a clinically extremely vulnerable person you should declare this in the relevant question. If you are unsure, please click here
The form will also ask you to confirm that you agree to your details being submitted and held by this system.
Your details are held securely for the purpose of the health declaration only. Your details will not be shared with anyone outside of your employer or ESS.
Once confirmation is provided to your employer, all details are removed from the system. If you have any concerns, please contact either your employer directly or our office firstname.lastname@example.org. To continue with the declaration, please select the button below.
Please complete all of the questions below, ensuring you answer all questions with a red asterisk.
An email confirmation will be issued to you as soon as your submission has been processed and submitted to ESS. Please check your spam folder if you have not received confirmation.
For any other questions, please contact ESS via email at , or telephone 0843 289 1097, opt 1
CLINICALLY EXTREMELY VULNERABLE PEOPLE
Clinically extremely vulnerable people may include the following people. Disease severity, history or treatment levels will also affect who is in this group.
Solid organ transplant recipients.
People with specific cancers:
people with cancer who are undergoing active chemotherapy
people with lung cancer who are undergoing radical radiotherapy
people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
people having immunotherapy or other continuing antibody treatments for cancer
people having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
people who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs
People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary (COPD).
People with rare diseases that significantly increase the risk of infections (such as severe combined immunodeficiency (SCID), homozygous sickle cell).
People on immunosuppression therapies sufficient to significantly increase risk of infection.
Women who are pregnant with significant heart disease, congenital or acquired.
People in this group should have been contacted to tell them they are clinically extremely vulnerable.
If you are still concerned, you should discuss your concerns with your GP or hospital clinician.