COVID Self-Declaration Form for attendance at meetings of Laois County Council


COVID Self-Declaration Form for attendance at meetings of Laois County Council

On the day of the meeting and prior to the meeting, all attendees are required to complete this COVID Self Declaration Form to determine the following questions

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? *
Have you been diagnosed with confirmed or suspected COVID-19 infection in the last 14 days? *
Are you a close contact of a person who has a confirmed or suspected case of COVID-19 in the past 14 days (less than two metres for more than 15 minutes accumulative in one day)? *
Have you been advised by a doctor to self-isolate at this time? *
Have you been advised by a doctor to cocoon at this time? *
Have you returned into Ireland from a non-green list country in the last 14 days? *

If the answer to any one or more of the questions is Yes – YOU MUST NOT ATTEND THE MEETING

This completed return will be held by the Meetings Administrator for a period of 14 days following the meeting after which time it will be destroyed.