Covid 19 Site Visitor Questionnaire

In order to implement COVID-19 Prevention and Control Measures, and minimise risk to staff and students, all visitors to our school are required to complete the following questionnaire prior to arrival.

Atlantic Site Visitor Survey Covid 19
Have you travelled 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? *
How is your health today, are you feeling well or unwell? *
Have you had any of the following in the past 14 days: cough, high temperature/fever, sore throat, runny nose, breathlessness, or flu-like symptoms? *
Have you been diagnosed with COVID-19 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 School immediately. I confirm that I have not been advised to self-isolate and am not 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 the above answers change, please let us know in advance of your visit.