QuickGalway

COVID19 Statement

I declare that I am in good health and with no underlying health conditions.

I declare that I have not developed any Covid19 or any flu symptoms (fever, cough, sore throat, running nose, muscular pain) in the past 5 days. I declare that I have not been diagnosed with confirmed or suspected COVID-19 infection in the last 5 days and that I have not been advised by a doctor to self-isolate at this time. 

I declare that I have not been in close contact with a person who is a confirmed or suspected case of COVID-19 in the past 7 days (this includes hospitals or any Covid19 red zones).



I declare that all the information provided in this form is, to the best of my knowledge and belief, accurate and complete.

I agree that I will submit a new form within 7 days if, due to a change of circumstances, any certification on this form becomes inaccurate.