Covid-19 Registration Form - Holy Cross Primary School

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Covid-19 Registration Form - Holy Cross Primary School

The following questions ask you for contact information and health questions specific to COVID-19. All adults visiting or working in this school must complete this form on each visit.
Please contact the school office on 028417 63743 for any assistance.
Many thanks for helping to keep us all safe.

Mrs Charlene Sloan
~ Principal ~

Email Address *

First Name *

Last Name *

Organisation *

Job Title *

Phone Number * *

Date *

YYYY

Time of entry * *

Time

Estimated time of departure *

Time

Is anyone in your household currently self isolating or has COVID-19? * *

Yes

Required

Do you believe you may have COVID-19? *

Yes

Required

Have you had any of the following symptoms? * *

High temperature

Loss of taste or smell

New continuous cough

Shortness of breath

None

Required

If you have answered yes to any of these questions, please follow PHA guidance. https://www.publichealth.hscni.net/covid-19-coronavirus Thank you for helping keep everyone safe. *

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