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NRG Health Screening Questionnaire
In the interest of safety for yourself, your fellow members and staff - please complete the health screen questionnaire below prior to returning to NRG clubs after COVID-19 closure.
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* Indicates required question
Email
*
Your email
Your full name
*
Your answer
Your mobile phone number
*
Your answer
Date due to attend
*
MM
/
DD
/
YYYY
At which club is your membership held?
*
Knocknacarra, Galway
Bohermore, Galway
River Lee, Cork
Xpress, Little Island, Cork
Have you been outside of the Republic of Ireland in the last 14 days?
*
Yes
No
Have you been in contact with a person with or displaying the symptoms of COVID-19 in the last 14 days?
*
Yes
No
Do you have now, or have you had in the last 48 hours, any of the following symptoms?
*
Cough
Fever
Shortness of breath
Excessive fatigue / tiredness (out of proportion to normal)
Sore throat
None of the above
If any of the above details change, I agree to notify my NRG club as soon as possible.
*
Yes
Required
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