Staff return to work questionnaire - long version - HANSFIELD EDUCATE TOGETHER NATIONAL SCHOOL

Hansfield ETNS

This questionnaire must be completed by staff at least 3 days in advance of returning to work. If the
answer is Yes to any of the below questions, you are advised to seek medical advice before returning
to school.

Please note: The school's Board of Management is collecting this sensitive personal data for the purposes of maintaining safety within the workplace in light of the Covid-19 pandemic.

The legal basis for collecting this data is based on vital public health interests and maintaining occupational health, and will held securely in line with our retention policy.

* Indicates required field

Staff member's name *

Has your child been diagnosed with confirmed or suspect COVID-19 in the last 14 days? *

Do you have 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 advised by a doctor to isolate your child at this time? *

Have you been advised by your doctor that your child is in the very high risk group? IF YES PLEASE LIAISE WITH YOUR DOCTOR AND PRINCIPAL BEFORE RETURNING YOUR CHILD TO SCHOOL. *

Have you been advised by the HSE that your child is a close contact of a person who is a confirmed or suspect case of COVID-19 in the past 14 days? *

Has your child been advised by doctor to cocoon at this time? *

By submitting this data, I confirm, to the best of my knowledge that my child has no symptoms of COVID-19, is not self-isolating or awaiting results of a COVID-19 test. *

TICK TO CONFIRM

Your name *

Submit

Covid-19 Questionnaire

Hansfield ETNS