Erin School Of English

1. In the last 14 days have you been in close contact with anyone who is a suspected or confirmed case of COVID-19 Virus?

YesNo

2. 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?

YesNo

3. Have you displayed any symptoms of COVID-19, or tested positive for COVID-19, within the last 14 days?

YesNo

4. Have you been advised to self-isolate at this time by a doctor or medical professional?

YesNo

If you are returning to the school following isolation please answer below questions:

5. Have you had a fever of 38.5% or more in the last 5 days?

YesNo

6. Have you had symptoms of Covid in the last 14 days?

YesNo

7. Do you have any symptoms of COVID-19 now?

YesNo

DECLARATION (Please read carefully)

I am familiarised with current restrictions in place in Ireland.
Yes
If I develop symptoms of COVID-19, or I am identified as a close contact of a COVID-19 confirmed case, I will not attend school and will book a PCR test as soon as possible.
Yes
I have read and understood the Erin School of English Safety Protocols.
Yes

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 it may be used for the purposes of contact tracing in relation to confirmed or suspected cases of Covid-19.

Full Name:*

Email:*

Student ID Number:*

Address in Ireland:*

Mobile:*

You will receive an email confirmation after you submit the form.

Please leave this field empty.