Athletics Ireland Covid-19 Health Screening Questionnaire:

To ensure the Safety & Health of all people interacting with our Club, all club members/parents/visitors must confirm in their booking that they have read this Declaration Form and can answer "NO" to all questions PRIOR to entering Crusaders Athletics Club

1. Have you visited any of the countries outside Ireland excluding Northern Ireland in the last 14 days?

Yes No

2. Are you suffering any flu like symptoms/symptoms of coronavirus covid-19? Yes No

3. Are you experiencing any difficulty in breathing, shortness of breath? Yes No

4. Are you experiencing any fever-like/Temperature symptoms? Yes No

5. Did you consult a Doctor or other medical practitioner within the last 14 days ? Yes No

6. Are you feeling unwell Health wise? Yes No

7. Have you been in contact with someone who has tested positive to Covid-19 in the past 14 days? Yes No

8. Have been around someone with symptoms of Covid-19 in the last 14 days? Yes No

9. Is a member of your household self-isolating?

Yes No

10. Are you in a period of self-isolation and/or cocooning under the current Health Policy Rules? Yes No

11. Are you in a high-risk health category? Yes No

​If you have answered “YES” to any of the questions above or have indicated to us that you have symptoms of COVID19 you should not proceed with your booking OR attend the athletics club.

You are prohibited from entering or using the grounds/facilities and are advised to seek professional medical help/assistance.

NOTE: When on site, please adhere to our on-site standard processes/procedures regarding infection control, i.e. social distancing, hand washing/hand sanitising and general coughing/sneezing etiquette?

To complete your booking you will be asked to confirm that you have read the Athletics Ireland Covid-19 health screening form and that you can answer no to all questions.

Do not attend training if you answer Yes to any question.