PARENTS PRE-RETURN TO RUGBY PERSONAL ASSESSMENT DECLARATION

Should you answer YES to any of the below questions you should NOT attend your club and before you return you should follow appropriate medical advice and guidelines.

PRE-RETURN TO RUGBY PERSONAL ASSESSMENT DECLARATION

1. Are you a close contact of a person who is a confirmed or suspected case of COVID-19 in the past 14 days (i.e. less than 2m for more than 15 minutes accumulative in 1 day) *YesNo

2. Have you been diagnosed with confirmed or suspected COVID-19 infection in the last 14 days? *YesNo

3. Have you been advised by a doctor to self-isolate at this time? *YesNo

4. Have you been advised by a doctor to cocoon or shield at this time? *YesNo

5. Are you feeling unwell, have felt unwell or suffered any the following symptoms in the past 14 days? *

CoughBreathing difficultiesFever/High TemperatureSore ThroatRunny NoseFlu-like symptomsRashLoss of smell/tasteNew Skin RashNone of the aboveNew Gastrointestinal Symptoms

6. Have you returned to Ireland from another country within the last 14 days? *YesNo

7. If yes, where?

8. I confirm that the above declaration is true, to the best of my knowledge and in accordance with my club/school’s code of conduct. I also confirm that I will abide by all government guidelines and make myself aware of any changes to same. Tick the below box to confirm

I confirm

9. Signature (confirm your name to act as signature): *

10. Date: *

COVID-19 Precautions

Whilst we as a club will be taking comprehensive measures to ensure we adhere to all safety guidelines, we would ask that all players/parents/guardians/spectators follow the below guidelines;

• Don’t Share water bottles
• Wash hands before and After training
• Don’t spit or clear nasal passages on the pitch
• Adhere to social distancing measures
• Do not shake hands, fist bump or high five
• If you feel unwell, notify your coach immediately

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