Mandatory Covid-19 Screening Form Students

Name*

Emerald Student ID*

Do you have symptoms of cough, fever, high temperature, sore throat, runny nose, breathlessness, flu like symptoms or loss or change to your sense of smell or taste now or in the past 14 days?*

Yes
No

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

Yes
No

Have you been in contact with any known or suspected cases of Covid-19 in the last 14 days (less than 2 metres for more than 15 minutes altogether in 1 day)?*

Yes
No

Could you be classified as a person falling into the “at risk” group (e.g. underlying health conditions which place you at increased risk)?*

Yes
No

Have you restricted your movements for 14 days on arrival to Ireland (with the exception of students arriving from “Green List” countries)?*

Yes
No

By completing this form, you are agreeing to the following:

You will remain in your accommodation, inform us and not come to school should you have any symptoms of Covid-19
If requested by the school, you will stay at home and self-isolate for the recommended period
You will follow Covid-19 prevention measures to the best of your ability
In the unlikely event that you will be unable to attend lessons because you have contracted Covid-19, you understand that you are not entitled to a refund
While efforts are made to protect students and staff, you understand that in the event that you contract Covid-19, Emerald cannot accept responsibility

Yes
No

Phone

This field is for validation purposes and should be left unchanged.

Adult Courses

Junior Courses

By completing this form, you are agreeing to the following: