Tipperary Athletics Contact Tracing And Covid-19 Health Screening Questionnaire -  County Senior & Masters 10 Mile Road Championships 2021
This form must be completed by all Athletes, Officials, Road Race Volunteers, Marshals & First Aid personnel who will be attending at Galbally for the County Tipperary Senior & Masters 10 Mile Road Championships on Sunday 12th September 2021. This form must be completed and submitted BEFORE you attend the event.
Sign in to Google to save your progress. Learn more
1. Club Name *
2. Your Name *
3. Category *
4. Your Phone Number *
5. Your E-Mail *
6. Do you have symptoms of cough, fever, high temperature, sore throat, runny nose, breathlessness, flu like symptoms, loss or change to your sense of smell or taste now or in the past 14 days? *
7. Have you been diagnosed with confirmed or suspected COVID-19 infection in the last 14 days or are you awaiting a test or test results? *
8. 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)? *
9. Have you  been advised by a doctor to self-isolate at this time? *
10. Have you travelled off the island of Ireland in the past 14 days?
Clear selection
11. If you answered Yes to Question 10, do you hold a Digital Vaccination Certificate or do you satisfy the government guidelines to the travel isolation restrictions on return?                                                                                                                                For up-to-date information on latest travel restrictions and requirements on travel into Ireland, please visit https://www.gov.ie/en/campaigns/75d92-covid-19-travel-advice/ *
If your answer is yes to questions  6, 7, 8, 9 or 10 and no to question 11 or you 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. *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Tipperary Athletics. Report Abuse
Google Forms