Web Form - Covid Home Testing Portal

Fields marked with an asterisk (*) are required

This form is for NELFT 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:» Not NELFT Staff?

* Date of Test:

* Lot number of test strip:

* Results:

If Invalid, has a repeat test been performed:

* Specimen Type:

Manufacturer of Test:

Comments about problems or performance of device:

Do you require email confirmation of your result?