Tipperary Athletics Contact Tracing And Covid-19 Health Screening Questionnaire -  County  Intermediate Road Championships 2021
This form must be completed by all Athletes, Officials, Road Race Volunteers, Marshals & First Aid personnel who will be attending at Carrick-On-Suir for the County Tipperary Intermediate Championships on Sunday 25th July 2021. This form must be completed and submitted BEFORE you attend the event.
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Club Name Moycarkey Coolcroo AC *
Your Name Billy Purcell *
Category *
0872467226 *
Your E-Mail bilpur9@gmail.com *
Do you or anyone in your household have symptoms of cough, fever, high temperature, sore throat, runny nose, breathlessness or flu like symptoms now or in the past 14 days? *
Have you or anyone in your household been diagnosed with confirmed or suspected COVID-19 infection in the last 14 days? *
Are you or anyone in your household 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 altogether in 1 day)? *
Have you or anyone in your household been advised by a doctor to self-isolate at this time? *
Have you or anyone in your household recently visited any countries outside Ireland excluding Northern Ireland? *
Are you or anyone in your household in a period of self isolation and/or cocooning?
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If your answer is yes to any of the above questions or have indicated to us that you have symptoms of COVID-19 you should not attend the event. You are prohibited from entering the venue and advised to seek professional medical help/assistance.
Important Disclaimer - When on-site at the Championships,  please adhere to our standard processes/procedures regarding infection control. i.e. social distancing, hand washing/hand sanitising and general coughing/sneezing etiquette. All data on this form is collected with your consent for the sole purpose intended and in line with the GDPR policy and privacy statement of Athletics Ireland which can be accessed here: https://www.athleticsireland.ie/about/gdpr. I accept the above Disclaimer. *
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