Drogheda Grammar School – Student Personal Health Declaration

IMPORTANT NOTICE – Do not complete before Friday, August 27th

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

Please provide details below of any other circumstances relating to COVID-19, not included in the above, which may need to be considered to allow your student's safe return to school e.g. returning from travel abroad?


Declaration (required):


Parent / Guardian Name (required)

If your situation changes after you complete and submit this form, please email safetyandhealth@droghedagrammarschool.ie. Further information on people at very high risk (extremely vulnerable) or high risk from COVID-19 can be found at link: https://www2.hse.ie/conditions/coronavirus/people-at-higher-risk.html

Details of current arrangements for travel overseas can be found set out at this gov.ie link

Please note: The school is collecting this sensitive personal data for the purposes of maintaining safety within the school environment 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 this data will be held securely in line with our retention policy.

This contact form and website are protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. The Drogheda Grammar School website Privacy Policy is available here. By clicking SUBMIT you accept that your data will be stored as per the terms of Drogheda Grammar School's Privacy Policy