Covid 19 Declaration Form

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Please fill out the following questions within 24hrs of the start time of the event

Full Name *

Phone *

E-mail

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

Yes

Required

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

Yes

Required

Have you been in close contact with a suspected or confirmed case of COVID-19 and you have not been double vaccinated more than 14 days ago and are over 16? *

Yes

Required

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 and you have not been double vaccinated more than 14 days ago and are over 16? *

Yes

Required

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

Yes

Required

Have you had any of the following in the last 48 hours? *

Yes

Cough

Fever

Shortness of breath

Excessive fatigue/tiredness

Sore throat

Headache

Abnormal aches/pains

Loss of taste or smell?

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

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