MTU Athletics - Track Night 2 - Covid-19 Screening Questionnaire for Athletes and Officials

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To be completed by all athletes and officials prior to arriving at the competition.

Name *

Club *

Which event are you participating in? (If you are taking part in two events then just choose one of the options) ,or are you an official ? *

Covid Questionnaire

To ensure the Safety & Health of all people attending the competition, all athletes must complete this declaration form prior to attending the meet. If you indicate that you have symptoms of COVID-19 or you have been abroad in the last 14 days with exception to Northern Ireland, you should not attend the competition.

Do you have symptoms of cough, fever, high temperature, sore throat, runny nose, breathlessness or flu like symptoms now or in the past 14 days?

Yes

Clear selection

Have you been diagnosed with confirmed or suspected COVID-19 infection in the last 14 days?

Yes

Clear selection

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)?

Yes

Clear selection

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

Yes

Clear selection

Have you recently visited any of the countries outside Ireland excluding Northern Ireland?

Yes

Clear selection

Are you in a period of self isolation and/or cocooning?

Yes

Clear selection

How are you feeling Healthwise?

Well

Unwell

Clear selection

Important information. If you answered 'YES' to any of the questions above or have indicated to us that you have symptoms of COVID-19 you should not attend the meet. When on-site, please adhere to our standard processes/procedures regarding infection control. i.e. social distancing, hand washing/hand sanitising and the wearing of masks when not running. All data on this form is collected with your consent for the sole purpose intended and in line with the GDPR policy and privacy statement of Athletics Ireland which can be accessed here: https://www.athleticsireland.ie/about/gdpr

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