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Covid 19 Pre-Travel to Ireland Questionnaire

In order to implement COVID-19 Prevention and Control Measures to Minimise risk, all students and leaders must complete the following questionnaire before traveling to Ireland.

Please note that all students and leaders arriving from non Green List Countries are required to isolate for 14 days upon arrival. This includes those returning from holidays.

Atlantic Pre-Travel Covid 19 Welfare Survey
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? *
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 2m for more than 15 minutes accumulative in 1 day)? *
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 the information provided here is correct and accurate and I understand that providing false information can result in instant removal from class without refund.

I consent to the use of my details 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.