Drogheda Grammar School – Student Personal Health Declaration

IMPORTANT NOTICE – Do not complete before Friday April 9th 

Should you answer “Yes” to any of the below – Email safetyandhealth@droghedagrammarschool.ie for further instructions

 

Student Name (required)

Year/Form of your son/daughter(required)

Has your son/daughter been in close contact (<2m for 15minutes or more) with anyone who is confirmed to have had COVID-19 virus in the last 14 days? (required)

YesNo

Has been in close contact (<2m for 15minutes or more) with anyone who is suspected of having COVID-19 virus in the last 14 days? (required)

YesNo

Does your son/daughter live in the same household with someone who has symptoms of COVID-19 who has been in isolation within the last 14 days? (required)

YesNo

Has your son/daughter been advised by a doctor to self-isolate at this time? (required)

YesNo

Is your son/daughter suffering now, or have you suffered any the following symptoms in the past 14 days? (required)

Cough: YesNo
Breathing difficulties: YesNo
Fever/ High temperature: YesNo
Sore Throat: YesNo
Runny Nose: YesNo
Flu Like Symptoms: YesNo
Rash: YesNo
Loss Of Smell/Taste: YesNo


Has your son/daughter been advised by a doctor to cocoon? (required)

YesNo

Has your son/daughter returned to Ireland from another country within the last 14 days? (required)

YesNo

Is your son/daughter awaiting the results of a COVID-19 test? (required)

YesNo

Is there someone in your household awaiting the results of a COVID-19 test?

YesNo

In the past 14 days, has your son/daughter been in contact with a person who is a confirmed or suspected case of COVID-19?

YesNo

I have read and agree with the Drogheda Grammar School COVID-19 Response plan and amendment to the Code of Behaviour Policy in line with school safety control measures (required)

Yes

My son/daughter has read and agrees with the Drogheda Grammar School COVID-19 Response plan and amendment to the Code of Behaviour Policy in line with school safety control measures (required)

Yes


Declaration (required):


Parent / Guardian Name (required)

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