Drum Community Centre: Covid-19 Contact Tracing Form
To help prevent the spread of COVID-19, each person visiting or using Drum Community Centre is asked to complete this form. This information will assist with contact tracing, if required. This information will not be used for any other purpose.

If you answer Yes to any of the following questions, please DO NOT ENTER THE BUILDING.

If your situation changes after you complete and submit this form, please inform us as soon as possible.

You should also use the COVID Tracker App and visit gov.ie and hse.ie if you require any further information.
Your Name *
Your phone number *
Please give your mobile number if possible or else your landline including area code
Group or Club
If you are completing this form on behalf of or as part of a Group or Club, please tell us the name of the Group or Club
Date and time of your booking or visit *
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Time
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Do you have symptoms of cough, fever, high temperature, sore throat, runny nose, breathlessness, flu like symptoms or loss or change to your sense of smell or taste now or in the past 14 days? *
Have you been diagnosed with confirmed or suspected 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 2 metres for more than 15 minutes altogether in 1 day)? *
Have you been advised by a doctor to self-isolate at this time? *
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