COVID-19: Return to Play Questionnaire.

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

To help prevent the spread of COVID-19 you must fill out a "Return to Play Health Questionnaire". Certain responses will prevent you from returning to GAA facilities, trainings and events in order to help protect the health and safety of all club members.

Full Name *

Contact information ( Mobile or email) *

NIE / DNI number (or passport no) *

Have you had contact with someone that tested positive in the last 14 days? *

Yes

Do you believe you may currently have COVID-19? *

Yes

Have you had any of the following symptoms of COVID-19 in the past 14 days? *

High Temperature ( Higher than 37.5 celcius)

A new continuous cough

New unexplained shortness of breath

Sore throat

Loss of sense of smell or taste or distortion of taste

Diarrhea

None of the above

Required

Have you been diagnosed with COVID-19 within the last 14 days? *

Yes

If you have answered "Yes" to any of the Questions above please stay at home and if you are unsure you should contact your local CAP by phone for further advice.

If you have answered "NO" to all of the questions above and agree to the statement below you may train and attend GAA events. Please digitally sign this form to confirm that the details above are true to the best of your knowledge, that you understand the risks involved in Participation and that you are participating on a voluntary basis and you can opt-out at anytime. You will abide by all government rules in regards to travel, Isolation, public and private events. You similarly agree to abide by all protocols specifically implemented by the club in relation to prevention of Covid-19 and understand and acknowledge that these protocols may change. If there should be any changes to your health and personal situation that would change any answer on this form you will immediately get in contact with a club committee member to inform them of the changes where you will be asked to complete a new form. ( All forms will only be accessible to elected committee members and no personal data will be shared with club members). Finally I acknowledge by ticking the box below that failure to follow the rules outlined here and to knowingly risk the health of other members I will face penalties up to and including exclusion from club? *

I understand and Confirm

Please confirm todays date. *

YYYY

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms