WSC COVID-19 Self Report Screening (Swimmers & Volunteers)

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Please answer the following questions (YES / NO) prior to travelling to any club-based activity and submit to the club as per their instructions.

This process must be completed for each and every race with your club that you intend to take part in.

Email *

Race Date *

Sunday 5th September

Trials, Sat 4th September

Swimmer Name *

Hat Number *

Member Category *

Seniors

Youths

Intermediate

Sprints

Junior Challenge

Volunteer

Have you travelled to any country (outside of all-Ireland) in the last 10 days and are required to self isolate ? *

Yes

Have you been diagnosed with COVID-19 in the last 10 days? *

Yes

Have you been in close contact with a suspected or confirmed case of COVID-19? *

Yes

Have you been in close contact with a person who is awaiting the results of a COVID-19 test because they are a suspected case or because they have been in close contact with a confirmed case? *

Yes

Have you been contacted by a member of Public Health about a recent case of COVID-19? *

Yes

Do you have any of the symptoms below in the last 48 hours? *

Cough

Fever

Feeling short of breath

Loss of taste or smell

Excessive fatigue/tiredness (out of proportion to normal)

Sore throat

Headache

General aches and pain (out of proportion to normal)

Gastrointestinal issues (e.g., Diarrhoea, Nausea, etc.)

NONE OF THE ABOVE

Required

If the answers to all questions are NO, you can attend the WSC race event

The submission of this form is deemed to be a signature for the purposes

A copy of your responses will be emailed to the address you provided.

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