COVID-19 Questionnaire

PLEASE COMPLETE EVERY DAY

Due to the COVID- 19 pandemic, Dorset College students and staff have found themselves in an unprecedented situation, with many working and studying away from campus. Dorset College understands that this is difficult. Our priority remains students' and staff's health, safety and well-being.

Now that we are planning for your return to Dorset, we must implement measures to protect all staff, students, and others in line with government protocol.

All students must do this from today:
- Complete this health and symptom check every day until asked.

PLEASE NOTE DURING YOUR STAY:
-If any time during the year, you have any symptoms or any other circumstances arise in relation to COVID-19, you must not attend campus.
-If you have symptoms, self-isolate at home and contact a Doctor.
-Please do not come to campus until all symptoms have cleared following self-isolation.

1 Student Details

2 Current Well-Being

3 What Next

Are you a Da Vinci Student?*
- Yes
- No
Name/s*
Surname/s*
Date of Birth*

DD
MM
YYYY
Da Vinci Email*
Please don't use characters such as: á,é,í,ó,ú etc.
Personal Email*
Dorset email address*

If you have
1. selected that you have COVID-19 symptoms,
2. that you have been advised to isolate, or
3. that you have been in close contact with a suspected or confirmed COVID-19 case or
4. that you have been diagnosed with COVID-19 or have entered Ireland from overseas within in the last 14 days

You SHOULD NOT travel to Ireland/come to the College.
Please follow the medical advice that you may have received. Make contact with the relevant person in your college.

If you have
1. indicated that you are not symptomatic,
2. not self-isolating and
3. have had no close contact with a person who is suspected or a confirmed COVID-19 case,

You CAN TRAVEL/ ATTEND COLLEGE.
Statement*
I have read and agree with the above statement.
Please provide details* below of any other circumstances relating to COVID-19, not included in the above, which may need to be considered to allow your safe return to work. Further information on people at higher risk from Coronavirus can be accessed here

COVID-19 Questionnaire

Diagnosed/ Suspected / Medical Advised