Covid Return to Work Declaration

In order to implement COVID-19 Prevention and Control Measures to Minimise risk to Staff and in accordance with the Return to Work Safely Protocol issued on May 9 2020, all staff are required to complete & submit the following questionnaire before they return to work in the school building.

Covid-19 Pre-Return to Work Form
Do you have, or have you had, 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 ? *
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 discuss to ensure your safe return such as concern for an underlying health condition, pregnancy or other. *

Confirmation and Data Protection

I confirm that the above information is correct. I agree that my data may be used to contact me to verify the provided information and that it may be used for the purposes of contact tracing in relation to confirmed or suspected cases of Covid-19.

I confirm to the best of my knowledge that I have no symptoms of COVID19. *
I confirm that I am not self-isolating or awaiting the results of a COVID19 test *

If any staff answer Yes to any of the questions, they are strongly advised to follow the medical advice they receive or seek medical advice before returning to work.