AAI Covid-19 Screening Questionnaire for Thu 30 July

The following form must be completed by all athletes and officials within 24 hours in advance of the competition.

Please note: you must show your completed questionnaire at the gate to gain access to the track area. There are 3 options:

  1. An email receipt will be sent to you when you complete the questionnaire. You can show this email receipt to the gate official on your smartphone or tablet.
  2. You can print the email receipt and show the paper copy at the gate.
  3. If you prefer, you can print the following form and fill in the paper copy.

Your Name (required)

Club Name and Location (required)

Your Mobile Number, or parents' number if U18 (required)

Your Email (required)

Time and Date of your visit
Thu 30 July 2020, 5:30 pm

To ensure the Safety & Health of all people attending the competition, all officials must complete this declaration form prior to entering on-site. If you indicate to us that you have symptoms of Covid-19 or you have been abroad in the last 14 days with exception to Northern Ireland, you should not attend the competition. Where this is the case, you are prohibited from entering the competition and advised to seek professional medical help/assistance.

Have you been in any countries outside Ireland (excluding Northern Ireland) in the past 14 days?
YesNo

Are you suffering any flu-like symptoms/symptoms of Covid-19?
YesNo

Are you experiencing any difficulty in breathing, shortness of breath?
YesNo

Are you experiencing any fever-like/temperature symptoms?
YesNo

Did you consult a doctor or other medical practitioner?
YesNo

How are you feeling healthwise?
WellUnwell

Have you been in contact with someone who has visited an affected region in the past 14 days?
YesNo

NOTE: When on site, please adhere to our on-site standard procedures regarding infection control, i.e. hand washing, hand sanitising and general coughing/sneezing etiquette. Please see the following AAI document for a summary of the measures

By using this form you agree with the club's Privacy Policy, and in particular Section 4 ("Website contact form"). Confirm agreement?