Dublin Athletics Board Covid-19 Screening Form

Please complete this questionnaire and submit before attending a Dublin Athletics event.

To ensure the Safety & Health of all people attending a Dublin Athletics event, everyone including athletes, officials, parents/guardians must complete this declaration form prior to entering event sites. If you have answered "Yes" to any of the questions below or have indicated to us that you have symptoms of COVID-19 you may not attend this event. You must complete all sections of this questionnaire in advance of attending any Dublin Athletics event. You will be prohibited from entering and advised to seek professional medical advice/assistance if you have answered “Yes” to any of the questions below.

N.B. All questions with * must be answered. For anyone who has recently travelled overseas please consult the  https://www.gov.ie/en/publication/77952-government-advice-on-international-travel/#travelling-to-ireland

 Parent/Guardian must complete this form if the named person is under 18 years old.
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1. Do you have symptoms of cough, fever, high temperature, sore throat, runny nose, breathlessness or flu like symptoms now or in the past 14 days? *
2. Have you been diagnosed with confirmed or suspected COVID-19 infection in the last 14 days? *
3. 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 2 metres for more than 15 minutes accumulative in 1 day)? *
4. Have you been advised by a doctor or the HSE to self-isolate at this time? *
In the event you answer YES to any of the above questions you are not permitted to attend the event, please acknowledge your understanding by ticking YES *
What Event are you attending? Please choose *
In what capacity are you attending, please choose *
Required
What is your name? *
What is the name of your club? *
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