Cobh Pirates RFC - Return to Play - Personal Assessment Declaration

Should you answer YES to any of the below questions you should NOT attend your club and before you return you should follow appropriate medical advice and guidelines.

Please input the date you will be attending the Paddocks for training or a Club event. *

YYYY

Have you been in close contact (<2m for 15minutes or more) with anyone who is confirmed to have had COVID-19 virus in the last 14 days? *

Yes

Have you been in close contact (<2m for 15minutes or more) with anyone who is suspected of having COVID-19 virus in the last 14 days? *

Yes

Do you live in the same household with someone who has symptoms of COVID-19 who has been in isolation within the last 14 days? *

Yes

Have you been advised by a doctor to self-isolate at this time? *

Yes

Are you suffering now, or have you suffered any the following symptoms in the past 14 days? *

Yes

Cough

Breathing Difficulties

Fever / High Temperature

Sore Throat

Runny Nose

Flu Like Symptoms

Rash

Loss of Smell / Taste

Have you been advised by a doctor to cocoon? *

Yes

Have you returned to Ireland from another country within the last 14 days? *

Yes

If yes to travel outside Ireland, where did you visit?

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