Return to Gaelic Games Personal Health Assessment and Declaration Your Name (required) Club (required) Team/code (required) 1. Have you been diagnosed with or do you believe you may currently have COVID-19? (required) YESNO 2. Have you been in close contact (<2m for 15 mins or more) with anyone who is SUSPECTED OR CONFIRMED to have the COVID-19 virus in the last 14 days? (required) YESNO 3. Have you had any of the following symptoms of COVID-19 in the past 14 days? (required) a) Fever/High Temperature (over 37.5C)? YESNO b) A new continuous cough YESNO c) Shortness of breath/breathing difficulties YESNO d) Loss of sense of smell, taste or distortion of taste YESNO e) Flu like symptoms, sore throat, or runny nose YESNO 4. Have you returned to Canada from another country within the last 14 days? YESNO If yes, where from? PRINT NAME (required) Signature (required) Date (required)
