St. Finbarr’s A.C. COVID-19 Health Screening Form Please enable JavaScript in your browser to complete this form.Date of SessionDD12345678910111213141516171819202122232425262728293031/MM123456789101112/YYYY202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920SessionPlease SelectMardyke Track at 18:00Monday Road Session at 18:15 (meet at top of Mardyke)Choose a Pod (only available pods will show)Please select Pod A: sub 6.30 minute mile/threshold pacePod B: over 6.30 minute mile/threshold paceNameFirstLastRolePlease SelectClub Member/ Session ParticipantCoachCOVID SupervisorPhoneEmailDo you have symptoms of cough, fever, high temperature, sore throat, runny nose, breathlessness or flu like symptoms now or in the past 14 days? YesNo Have you been diagnosed with confirmed or suspected COVID-19 infection in the last 14 days?YesNoAre 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 2 metres for more than 15 minutes altogether in 1 day)? YesNoHave you been advised by a doctor to self-isolate at this time? YesNoHave you recently visited any of the countries outside Ireland excluding Northern Ireland?YesNoAre you in a period of self isolation and/or cocooning?YesNoPhoneSubmit
