Volunteer Health Survey

Introduction

Your health and wellbeing is important to us; Health & Safety regulations require us to ensure that you will not be put at risk from Covid-19 by volunteering in one of our shops or departments.

Please answer the following questions in full and click the submit button at the end of the form.  We must ask these questions to remain compliant with our health and safety policies.

Please note that the information you provide will be dealt with in line with GDPR.

Thank you

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Notes

  • There are mandatory questions and optional questions.
  • Please indicate if you have a diagnosed underlying health condition and if so, whether this falls into category A, B, C below. If none of these apply please select “D”.
  • If you have selected category “C” please provide details of your condition in comments box “F”.
  • If you live with someone who is “Clinically Extremely Vulnerable” or in Group C, please add comments in box “ F “.
  • If you are currently under investigation for a medical condition please add comments in box F.
  • * indicates that an answer is required before the form can be submitted.
  • Please click Submit and your form will be sent directly to the Volunteer Team.

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  • A. Clinically Vulnerable People Group

    Clinically vulnerable people are those who are:

    1. Aged 70 or older (regardless of medical conditions)
    2. Under 70 with an underlying health condition listed below (that is, anyone instructed to get a flu jab each year on medical grounds)
    3. Chronic (long-term) mild to moderate respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis
    4. Chronic heart disease, such as heart failure
    5. Chronic kidney disease
    6. Chronic liver disease, such as hepatitis
    7. Chronic neurological conditions, such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS), or cerebral palsy
    8. Diabetes
    9. A weakened immune system as the result of certain conditions, treatments like chemotherapy, or medicines such as steroid tablets
    10. Being seriously overweight (a body mass index (BMI) of 40 or above)
    11. Pregnant women
  • B. Clinically Extremely Vulnerable Group

    Clinically extremely vulnerable people are those who are:

    1. Solid organ transplant recipients
    2. People with specific cancers:
      • People with cancer who are undergoing active chemotherapy
      • People with lung cancer who are undergoing radical radiotherapy
      • People with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
      • People having immunotherapy or other continuing antibody treatments for cancer
      • People having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
      • People who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs
    3. People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary (COPD)
    4. People with rare diseases that significantly increase the risk of infections (such as SCID, homozygous sickle cell)
    5. People on immunosuppression therapies sufficient to significantly increase risk of infection
    6. Women who are pregnant with significant heart disease, congenital or acquired

    You should have received a Shielding letter from NHS England.

  • C. Received a shielding letter in the past from the NHS England for another specified reason
  • D. None of the Above
  • From the list below please select a Category based on the Descriptions above
  • Optional Questions:

    (Please select the options applicable to you)

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