C-19 Health Questionnaire

Do you have symptoms of cough, fever, high temperature, sore throat, runny nose, breathlessness, change or loss in taste or smell or flu like symptoms now or in the past 14 days.

Have you been diagnosed with confirmed or suspected case of COVID-19 infection in the last 14 days.

Are you a close contact of a person who is a confirmed or suspected case of COVID-19 in the past 14 days (i.e. less than 2m for more than 15 minutes accumulative in 1 day)?

Have you been advised by a doctor to self-isolate at this time?

Have you been advised by a doctor to cocoon at this time?

Have you travelled outside of the Island of Ireland in the last 14 days?

Please state which country and date returned.

Country

Date

State date of onset of symptoms and date of test results received.

Date of Symptoms

Date of Results

If you develop any of the above symptoms before attending the course or have reason to suspect you have had close contact with an Covid-19 infected person, then you are to stay at home, inform us and to call your doctor.

COVID-19

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