Web Form - Covid Home Testing Portal

Fields marked with an asterisk (*) are required

This form is for BHRUT staff taking part in the NHS asymptomatic staff Covid-19 home testing programme.
You will need to complete this form twice a week after you take each test.

* First name (as appears on payslip):

* Last name (as appears on payslip):

* Email:

* Assignment number (found on payslip):

* Gender:

* Date of Birth:

* Home Postcode:

* Date of Test:

* Hour:

* Minute:

* Lot number of test strip:

* Results:

If invalid, has a repeat test been performed:

Comments about problems or performance of device: