Covid-19 Screening Declaration for Visitors

To help prevent the spread of COVID-19 and reduce the potential risk of exposure, we are conducting a simple screening declaration form (“Declaration”).

Required to be submitted by every Contractor and Visitor, prior to access to our facilities.

Your participation is important to help us take precautionary measures to protect you and everyone associated with the School.

I hereby certify that I have not within the last 14 days;

  • Tested positive with the Coronavirus or been identified as a potential carrier
  • Experienced any symptoms commonly associated with the Coronavirus
  • Been in any location designated as a risk by the Government or Public Health England
  • Been in direct contact with or in the immediate vicinity of any person been identified as a carrier or potential carrier of the Coronavirus.
  • Not visited any regions/countries that require a quarantine upon return.


I acknowledge and accept that this declaration will be considered as my consent to record and store this declaration for the purpose of ensuring the safety of all persons that may encounter me during my time in the School premises.

It will be retained at the point of collection and will only be accessed by authorised employees. We will only retain this information for as long as it remains relevant and for a maximum of six months. Luckley House School Privacy Notice is available on request.