Erin School Of English

1. Have you traveled outside the REPUBLIC OF IRELAND within the past 14 days?

YesNo

2. Have you been in close contact with anyone who is a suspected or confirmed case of COVID-19 Virus?

YesNo

3. 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

4. Have you displayed any symptoms of COVID-19 within the last 14 days?

YesNo

5. Do you use Public Transport or do you share transport with other persons than those within your immediate accommodation?

YesNo

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

6. Are you free from a fever 38.5 C for the last 5 Days?

YesNo

7. Has it been 14 days since your first symptom appeared?

YesNo

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

YesNo

DECLARATION (Please read carefully)

I have completed the COVID-19 Passenger Locator Form before arrival.
Yes
I have read and understood my obligations to restrict my movements after arriving in Ireland. I declare to follow the government regulations.
Yes
I am familiarised with current restrictions in place in Ireland.
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.

Date of arrival in Ireland:*

Full Name:*

Email:*

Student ID Number:*

Address in Ireland:*

Mobile:*

Please leave this field empty.