COVID 19 Care Homes Staff Self Isolation Report

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1. Provider name*
2. CQC ID
3. Date*
4. How many staff work in your organisation?*
5. How many care staff are currently self-isolating because of actual or suspected COVID-19 symptoms?*
6. How many non-care staff are currently self-isolating because of actual or suspected COVID-19 symptoms?*
7. Your name*
8. Your email address*
  Please enter your email address so that we can send you a confirmation of the information you have submitted
9. I confirm that the information I have submitted is, to the best of my knowledge correct*
  
  I agree