GYM 208 HEALTH QUESTIONNAIRE
To be completed before you undertake any form of exercise with Gym 208 at Glenariffe Community & Recreation Centre from 1 July 2020.
  • Yes No
    Have you been diagnosed with or do you believe you may currently have COVID-19?
    Have you been in contact with a COVID-19 confirmed or suspected case in the past 14 days?
    Have you had any signs of a temperature higher than normal (ie over 37.5c) in the past 14 days?
    Have you experienced any new unexplained shortness of breath in the past 14 days?
    Have you developed a new or continuous cough in the past 14 days?
    Have you experienced any change to your sense of smell or taste the past 14 days?
  • For Information

    If you have answered YES to any of these questions, or if your temperature as recorded today is over 37.5°c, you must not attend any form of exercise organised by Gym 208 at Glenariffe Community & Recreation Centre. You should stay at home and contact your GP by phone for further advice.

    In submitting this form, you are confirming that the details above are true to the best of your knowledge and that you understand and accept the risks involved in attending.

    Thank you for completing this questionnaire.