Athletics Ireland (Lusk AC) COVID-19 health screening form
This form is for all club members to complete before they attend the club for training. This form must be completed and submitted before you attend training or events.
Club name: *
Your name: *
Your phone number: *
Your email: *
Do you have symptoms of cough, fever, high temperature, sore throat, breathlessness or flu like symptoms now or in the past 14 days? *
Required
Have you been diagnosed with confirmed or suspected COVID-19 infection in the last 14 days? *
Required
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)? *
Required
Are you a member of a workplace, social group or club with a confirmed or suspected case of COVID-19 that you have been advised not to attend in the past 14 days? *
Required
Have you been advised by a doctor to self-isolate at this time? *
Required
Have you recently visited any country not on the Green List? *
Required
Are you in a period of self isolation and/or cocooning? *
Required
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