Thursday 21 January 2021
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Salisbury Foundation Trust
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Staff self-testing form

Staff self-testing form

This information is for staff of Salisbury District Hospital only

 

Please use this form to submit the results of your staff home tests (lateral flow tests) only.

  • You should take a test on agreed specific days.  You will be tested twice weekly and on the following specified days:

    • Monday and Thursday

    • Tuesday and Friday

    • Wednesday and Saturday  

  • It's important that all test results are submitted for every test you take
  • Please submit the results within 24 hours of the test

If your test was positive, please submit this form and contact Occupational Health, Monday – Friday and between the hours of 08.00-16.00 and on extension 5638

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

Your Information

Terms & conditions

  • I understand that the supply of testing kits which has been issued to me must only be used by myself and that I must not share them with other staff or family and friends
  • I understand that I must store these testing kits safely at home
  • I understand that it is my responsibility to arrange collection of further testing kits with my line manager and ensure that I have no less than 4 kits at home.
  • I understand that I will complete this test before attending work on my agreed testing days
  • I understand that should I test positive, I will immediately contact my line manager and occupational health, following existing Salisbury NHS Foundation Trust policy for requesting a PCR test

Please use the date picker to select your date of birth
Employee number (assignment number) as shows on payslip
Test information
Lot number of test (you can find this on the outside of the test kit packaging)
Please use the date picker to select when your test was taken



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Our staff at Salisbury District Hospital have long been well regarded for the quality of care and treatment they provide for our patients and for their innovation, commitment and professionalism. This has been recognised in a wide range of achievements and it is reflected in our award of NHS Foundation Trust status. This is afforded to hospitals that provide the highest standards of care.

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Salisbury NHS Foundation Trust, Salisbury District Hospital, Salisbury, Wiltshire, SP2 8BJ
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