Covid 19 Host Family Questionnaire

In order to implement COVID-19 Prevention and Control Measures to Minimise risk to Staff & Students ,our enhanced Health and Safety Protocols now require all Host Families to complete the following questionnaire before returning as a host family

Atlantic Host Family 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 COVID-19 . If I do experience symptoms I will advise Atlantic Language , self-isolate until I am medically confirmed safe to resume as a Host Family. I confirm that I am not self-isolating or awaiting the results of a COVID-19 test.

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.