COVID 19 Risk Assessment

COVID-AGE individual vulnerability questionnaire

Information for candidates

There is growing evidence that certain specific groups and characteristics make some individuals more vulnerable to COVID-19. The purpose of this health questionnaire is to only help and inform both the employee and their employment agency on how to identify those individuals with underlying conditions or have identified increased risk factor(s) that may put them at increased or extreme risk in the workplace.

What is COVID-age?

Covid-age is a tool to help assess an individual’s overall vulnerability to Covid-19. It is simple, it is evidence-based, and it allows us to summarise a range of risk factors into a single figure: these factors include age, sex, and ethnicity, not just comorbidities. Covid-age does not provide an exact measure, so when it is used to calculate vulnerability from medical conditions, particularly multiple medical conditions, clinical judgement must also be used.

Covid-age is intended as an occupational health tool to help assess fitness for work. It is not intended for use in clinical treatment pathways.

The risk that someone will get the infection through work can be reduced through control measures that minimise workplace exposure and through use of personal protective equipment. People who are clinically extremely vulnerable are at high risk of getting seriously ill from coronavirus (COVID-19). If you considered clinically extremely vulnerable, should have received a letter advising you to shield or have been told by your GP or hospital clinician.

Do you have a shielding letter, shielding condition or vulnerable condition?(Required)

Yes

As you answered ‘yes’ you should adhere to the following guidance: Guidance on Sheilding

About you

Your name(Required)

First Last

Your email address(Required)

Job title / speciality(Required)

Date of birth(Required)

Day

Month

Year

Vulnerability from risk factors

Expressed as equivalence to added years of age

Gender (as assigned at birth)(Required)

Male

Female

Ethnicity(Required)

BMI (Body Mass Index)(Required)

COVID risk factors

Please indicate whether any of the following apply to you.

Asthma(Required)

Yes

Is your asthma..(Required)

Mild

Severe (requiring oral corticosteroids in past year)

Diabetes(Required)

Yes

Is your Diabetes...(Required)

Controlled (HbA1c<58 mmol/mol)

Uncontrolled ( HbA1c≥58 mmol/mol)

No HbA1c measure in last 15 months

Chronic heart disease(Required)

Yes

Chronic respiratory disease(Required)

Yes

*excluding asthma

Non-haemological cancer(Required)

Yes

Was your Non-haemological cancer...(Required)

Diagnosed <1 year ago

Diagnosed 1-4.9 years ago

Diagnosed ≥5 years ago

Haemological malignancy(Required)

Yes

Was your Haemological malignancy...(Required)

Diagnosed <1 year ago

Diagnosed 1-4.9 years ago

Diagnosed ≥5 years ago

Liver disease(Required)

Yes

Chronic Neurological disease other than stroke or dementia(Required)

Yes

*excluding stroke or dementia

Organ transplant(Required)

Yes

Spleen diseases(Required)

Yes

Rheumatoid/ lupus/psoriasis(Required)

Yes

Other immune-suppressive conditions(Required)

Yes

Pregnancy

Are you pregnant?(Required)

Yes

Estimated delivery date(Required)

Day

Month

Year

Additional notes

BAME - Ethnicity and COVID-19

There is significant concern at present about possible increased vulnerability for BAME individuals, particularly those working in healthcare roles where they may be at increased risk of exposure. It is unclear at present whether this represents an additional vulnerability related to ethnicity or whether this represents an increase in the comorbidities in this group that are known to increase vulnerability.

Asthma

The NHS now say that you would be considered at very high risk if ALL THREE of these things apply to you:

You have asthma, AND
You are taking certain extra controller medicines as well as a preventer inhaler (for example, you are taking Montelukast, salmeterol or formoterol, or you are on a combination inhaler like Seretide, Fostair, Symbicort, Flutiform, Fobumix, DuoResp Spiromax, Combisal, Sereflo, Sirdupla, Aloflute, AirFluSal, Relvar Ellipta, Fusacomb or Stalpex), AND
You are taking continuous or frequent oral steroids.

Pregnancy

Existing guidance identifies that pregnant women over 28 weeks should be regarded as at increased risk and recommended to stay at home. For pregnant women with underlying health conditions at any stage of pregnancy a more precautionary approach is required, and ethnicity should be included in the consideration and discussion between healthcare staff and managers. Where pregnancy is under 28 weeks gestation working in a patient facing environment should be on the basis that the risk assessment supports this.

Vulnerability level	Definition	Workplace considerations
Very High Covid-age Mid-70s and above	High risk of death if infection occurs. Those who must take great care when they leave the security of their own home.	Ideally work from home. If attending work, the risk should not be significantly greater than the risk within their own home. Ensure low likelihood of anyone breaching social distancing. Ensure they can maintain good personal hygiene and with low likelihood of contacting contaminated objects and surfaces.
High Covid-age 60s to mid 70s	High risk of becoming hospitalised and seriously ill if infection occurs. Those that can leave their home to go shopping or for a walk in the park, and associate freely with other members of their household.	OK to attend work if the risk of doing so is no greater than the risk of shopping in the local supermarket, or social distancing in the streets, parks and countryside. Keep the risk in the workplace as low as reasonably practicable by redeployment or controls including PPE. Clinical work, care work and working closely with others (such as teaching, sharing a vehicle, using public transport) may be possible provided controls (e.g. screens, PPE) are effective in managing the risk. Some individuals in essential roles may be asked to accept higher risk and agree to do so where this can be justified.
Moderate Covid-age 40s and 50s	Those who much less likely to develop severe disease if infection occurs.	A moderately increased risk of infection may be accepted where there are no reasonably practicable means of reducing it further. Includes clinical work with higher hazard and risk levels, or roles where physical control or restraint is required, or where additional risk has to be accepted and can be justified.
Low Covid-age below around 40	Those who are very unlikely to develop serious disease if infection occurs.	Increased risk of infection may be accepted where there are no reasonably practicable means of reducing it further.
Pregnancy	No current evidence of significantly increased risk to mother or baby unless mother has significant medical problems.	Current advice is to minimise the risk to pregnant women, while allowing them to choose whether to attend work and what role to undertake at work. Risk should be reduced as far as reasonably practicable.

Signature

Name

This field is for validation purposes and should be left unchanged.

COVID-AGE individual vulnerability questionnaire

Information for candidates

What is COVID-age?

Covid-age is intended as an occupational health tool to help assess fitness for work. It is not intended for use in clinical treatment pathways.

About you

Vulnerability from risk factors

COVID risk factors

Pregnancy

Additional notes

BAME - Ethnicity and COVID-19

Asthma

Pregnancy

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