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In the event of a positive case of COVID-19 in the University community the role of contact tracing will be undertaken by the HSE. In such a scenario, it is the responsibility of each member of the University community to be in a position to provide the HSE with details of their contacts, if requested.

In order to comply with the requirements of the Government's Return To Work Safety Protocol all staff and research postgraduates must complete this form for every day that they attend campus. The information supplied will be used to assist in contact tracing in the event of a Covid 19 case in the University community and will be destroyed after 28 days. The following UCD Return to Work Safely Privacy Notice covers the data processing for UCD to meet its obligations under the Covid-19 National Return to Work Safely Protocol: https://www.ucd.ie/sirc/coronavirus/returntocampusworking/

You only need to complete this form ONCE per daily visit.

By continuing with this form you confirm that:
• You are not experiencing any symptoms of Covid 19 (https://www2.hse.ie/conditions/coronavirus/symptoms.html) - fever, cough, shortness of breath, loss or change in sense of smell or taste
• You have not been advised to self isolate for any reason e.g. due to a positive diagnosis of Covid 19, due to being a close contact of a confirmed case, etc.
• You have completed any necessary isolation period advised following any return from abroad
• You have completed your company or UCD's Covid 19 induction training (https://www.ucd.ie/sirc/coronavirus/returntocampusworking/)

Email address *
Group / Company: *
Mobile Phone Number: *
UCD Activity Coordinator Name *
Please enter the name of the person in UCD you are coordinating with for the activity today
UCD Activity Coordinator Contact Number: *
Building Access: *
If 'Other' selected, please specify:
Time of Arrival *
Time
:
Time of Departure *
Time
:
Please record details of your activities on campus for this day. In particular please detail those persons / cohorts / classes with whom you have spent more than 15 minutes at less than 2m physical distance, and those persons / cohorts / classes with whom you have shared a space with for more than 2hrs during the day:
A copy of your responses will be emailed to the address you provided.
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