Scroll down

Coronavirus staff guidance University Hospitals Birmingham NHS Foundation Trust

Self-testing kits reporting form

Last updated: 23 May 2023 at 09:35

Please use this form to submit results of your lateral flow tests only.

Symptomatic staff, as set out in the testing and sampling guidance, can order lateral flow tests (LFTs) from the website.

In specific circumstances, such as an outbreak, LFTs may be issued by the Infection Prevention and Control team.

  • It's important to submit results for every test you take
  • Please submit the results within 24 hours of the test
  • Please follow the test result guidance as set out in the testing and sampling information

If your test shows an invalid result, please submit this form and take another test straight away. Please ensure you also submit the results of the second test.

Your information

Your date of birth [Required]
Gender [Required]
Division [Required]
Site [Required]
Your ethnicity (please note the following options were set by Public Health England) [Required]
Your COVID vaccination status: [Required]

Test information

Reason for carrying out your test [Required]
Where did you obtain the test kit used to carry out this test? [Required]
Date test was taken [Required]
Time test was taken (please use 24-hour format) [Required]
Test result [Required]

(Please see the testing guide for details of how to interpret results shown on the device.)

Privacy statement

The information you provide on this form will be shared with Public Health England as part of the ongoing national response to the COVID-19 pandemic. Please see the relevant section on the full privacy notice for staff for more information, or contact the Information Governance team if you have any queries.

To prevent attacks by malicious software, this site is protected by reCAPTCHA, and the Google Privacy Policy and Terms of Service apply.

Back to top