Dublin Chapter
Health Questionnaire
November 2021
I __________________________________ CONFIRM THAT:
• I have not been diagnosed with, or cared for someone diagnosed with COVID-19 in the past two weeks
• I have not shown symptoms of COVID-19 or come in close contact with anyone exhibiting these symptoms in the past two weeks
• I do not have a cough, fever, chills, shortness of breath, or loss of taste or smell
• If I begin to show symptoms of COVID-19 within the next two weeks, I will contact Dublin Chapter
• I will follow all Dublin Chapter covid rules and guidelines to keep myself, members and those around me safe
• I confirm that I possess a Covid-19 Vaccination Certificate and have presented same to the Dublin Chapter Covid Officer
Signature_______________________________________________
Date___________________________________________________
Chapter Use only
All boxes have been ticked by Dublin Chapter member and checked by Covid Officer.
Signed (Covid Officer) __________________
Rules for the safe return of Dublin Chapter to monthly meetings .

We will not be serving Tea or Coffee for the initial meeting until we establish how members feel regarding their safety.
The aim of these rules are for the safety of all our members.
1. Health Questionaire must be completed by all members returning to meetings,
2. Masks must be worn at all times.
3. Hand sanitising must be used on entering and leaving meetings.
4. Covid distancing must be kept whether seated or standing unless related or travelling together.
5. All members must adhere to current Covid 19 regulations and guidelines.

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