Covid 19 Health Questionnaire

In order to implement COVID-19 Prevention and Control Measures to Minimise risk , Atlantic Language School requires all students to complete the following questionnaire before a student can return to the school. This questionnaire is ONLY for students already in Ireland.

Atlantic In Ireland Covid 19 Welfare Survey
Have you traveled outside the REPUBLIC OF IRELAND within the past 14 days? *
Have you been in close contact with anyone who is a suspected or confirmed case of COVID-19 Virus? *
Do you live in the same house as someone who is showing symptoms of COVID-19 or who has been isolating within the last 14 days? *
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? *
Have you been diagnosed with a confirmed or suspected COVID-19 infection in the last 14 days? *
Have you been advised by a doctor to self-isolate at this time? *
Are there any other circumstances relating to COVID19 not on this form that you may need to consider to ensure your safety? These include concerns for an underlying health condition, pregnancy or other. *

I confirm to the best of my knowledge that I have no symptoms of COVID19 . If I do experience symptoms I will advise Atlantic Language , self-isolate and stay away from the Atlantic Language School until I am medically confirmed safe to return. I confirm that I am not self-isolating or awaiting the results of a COVID19 test. In addition I confirm that I understand that the information provided here is accurate and that providing false information can result in instant removal from class without refund.

I consent to the use of my information for the purpose of processing this form. *

If any of your answers above ever change, please let us know in advance of attending the school.