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  • 1. Introduction
  • 2. Your details
  • 3. Medical details
  • 4. Confirmation

Covid-19 Assessment

The purpose of this questionnaire is to assess your vulnerability to Covid-19.

The vulnerability of an individual is the risk that, once infected with Covid-19, they will develop serious illness and possibly die. A person's risk of serious Covid-19 is a combination of their vulnerability and the risk that they get infected. The risk of getting infected depends on the prevalence of virus in the local community (which can vary over time), and personal circumstances and activities that predispose to contact with the virus.

The risk that someone will become infected through work can be reduced through control measures that minimise workplace exposure and through use of personal protective equipment. If the risk that someone will get the infection through work remains higher than their risk of becoming infected outside work, then, for the individual worker, their personal vulnerability becomes important. The information you provide will help to determine whether you are Low Risk, Moderate Risk, High Risk or Very High Risk. To make this determination, we will use a tool called Covid-age that helps assess a person's vulnerability to Covid-19.

What is Covid-age?

Covid-age is based on published evidence for the main identified risk factors. That evidence indicates that vulnerability to Covid-19 increases exponentially with age; for example, in comparison with a healthy person aged 20, a healthy person aged 60 has more than 30 times the risk of dying if they contract Covid-19. Covid-age summarises vulnerability for combinations of risk factors including age, sex, ethnicity, body mass index (BMI) and various health problems. It works by 'translating' the risk associated with each factor into years, which are added to (or subtracted from) an individual's actual age.

Once you complete the following questions your answers will be used to calculate your Covid-age and a risk assessment will be completed and emailed to you and the person who made this referral. For those people identified as being at higher risk, the tool may trigger a referral to Occupational Health for a video consultation.

Please indicate, by ticking the box below, that you are happy for us to email this to the person who made this referral. Please note the only information on this report will be your Covid-age and what control measures are required to be put in place to reduce your risks further, for example the type of personal protective equipment you should be provided with.

Information on how we process your data, consent, privacy and confidentiality can be found at:

If we need any more information, or if we need to arrange a consultation, we will contact you. Please do NOT phone us. Check your emails regularly (including your Spam/Junk emails) and please ensure you are contactable on your mobile phone, both during the day and evenings and at weekends.

Please start by completing Section 2 and go on to Section 3.

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