Buíon Setanta 5th Louth, Louth Scout County for Covid-19 Online Form
This questionnaire must be completed in advance of each face to face meeting or activity. All questions relate to the youth member.

The aim of this form is to welcome you the youth member, back to Scouting. We wish to ensure that you are healthy and well. This form also seeks confirmation that you are not self-isolating, restricting your movements or awaiting the results of the Covid-19 test.

If the answer is Yes to any of the questions below, or if your temperature as recorded today was over 37.5 degrees Celsius, you should stay at home and contact your GP by phone for further advice.

Please note:
Your Scout Group are collecting this sensitive personal data for the purposes of maintaining safety within Group meetings and activities in light of COVID-19 pandemic. The legal basis for collecting this data is based on vital public health interests and maintaining the health of our members. This data will be retained securely and only for the purposes outlined above.
Name (Youth Member`) *
Do you have symptoms of cough, fever, high temperature (i.e. 37.5 degrees Celsius or over), sore throat, runny nose, breathlessness or any flu-like symptoms now or in the past 14 days? *
Have you been diagnosed with or do you believe you may currently have Covid-19? *
Have you been advised by the HSE that you are a close contact of a person who is a confirmed or suspected case of COVID-19 in the past 14 days? *
Have you been advised by your doctor that you are in the very high-risk group? (If yes, please liaise your Scout Leader in advance of attending any scout meetings or activities). *
Are you currently awaiting results of a COVID-19 test or been advised to restrict your movements? *
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