2023 FINAL - PCL COVID On Call First Responder form for covid positive students STUDENT First Name * STUDENT Surname * STUDENT Room number * Are they in an ensuite room? * No Yes Please state where the student will be going to isolate * Offsite - Will be leaving College to stay with family or friends Will be staying at College in Room STUDENT Best contact number * Date of COVID positive RAT or PCR test? * STUDENT Next of kin name * STUDENT Next of kin contact number * Confirm Date for End of Isolation Period (for meal delivery if you remain on-site): Do you have any dietary requirements? Yes No If so, what are your dietary requirements? Are they unwell, do they need an ambulance? * No Yes If the student is acutely unwell, tell them to please go to the nearest emergency department or call an ambulance Does the student have any medical conditions that may impact them during isolation? * No If Yes, please give detailsIf Yes, please give details Has the student had Covid vaccination? * Yes No PCL First responder name * PCL First responder surname * PCL First responder mobile: * PCL First Responder email: * If you are human, leave this field blank. Submit
