First Steps Academy Creche & Montessori

COVID-19 Declaration Form

First Name:

Surname:

Email:

Phone:

Do you have symptoms of cough, fever, high temperature, sore throat, runny nose, breathlessness or flu like symptoms now or in the past 14 days?

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

Were you a close contact of a person who is a confirmed or suspected case of COVID-19 in the past 14 days or have you been advised by a doctor or HSE Public Health to self-isolate in the past 14 days?

Do you have any further relevant information that may affect you, relating to COVID-19, not included in the above, which may need to be considered to allow your return to/start work?

Any Further Information (Optional):

COVID-19 Declaration Form

Get in touchinfo@firststepsacademy.ie01 - 555 5158

Get in touch
info@firststepsacademy.ie
01 - 555 5158