Mirror Nationals event SYC COVID Questionnaire

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Welcome to the Mirror Nationals sailing event to be held at Sligo Yacht Club 20th - 22nd August 2021. In line with the Covid guidlines, we would be grateful if all participants and attendees would complete this form by 8am on Friday 20th August.

First Name *

Surname *

Do you have symptoms of cough, high temperature, breathlessness, or loss or change to your sense of smell or taste now or in the last 14 days? *

Yes

Have you been diagnosed with confirmed or suspected Covid-19 infection in the last 14 days? *

Yes

Are you a close contact of a person who is a confirmed or a suspected case of Covid-19 in the past 14 days? (A close contact is defined as spending more than 15 minutes of face-to-face contact within 2 metres of someone who has COVID-19, indoors or outdoors, or living in the same house or shared accommodation as someone who has COVID-19) *

Yes

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

Yes

Have you travelled from any location not on the current Government green list in the last 14 days? *

Yes

I agree to advise Sligo Yacht Club if there are any changes in my health status during the event *

I agree

If you have answered yes to any of these questions you should stay at home and contact your GP for further advice. Please keep your close contacts to a minimum.

If you have answered no to all the above questions we look forward to welcoming you at the club!

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms