Please fill in the questionnaire below with your details.Please complete within 24 hours prior to arrival at Down Syndrome Limerick.
Do you have any symptoms of Covid-19 now or in the last 14 days (see table below)? YesNo
Have you been diagnosed with confirmed/suspected COVID-19 in the last 14 days? YesNo
Are you a close contact of a person who is a confirmed/suspected case of COVID-19 in the past 14 days? YesNo
Have you or any member of your family been advised by a doctor to self-isolate at this time? YesNo
Declaration: I declare that the above information provided by me is true, accurate and complete in all respects.
Please do not attend the service if you answer Yes to any of the above questions. While we understand this might cause an inconvenience to you, we are acting in the best interest of all of our members.
Symptoms of Covid-19::
Common Symptoms
Less Common Symptoms
Severe Symptoms
Fever (temperature > 38C)
Change to sense of smell
Shortness of breath
Chills
Change to sense of taste
Loss of appetite
Dry cough
Nasal congestion
Confusion
Fatigue
Conjunctivitis
Chest pain/pressure
Sore throat
Headaches
Muscle of joint pain
Skin rash
Nausea, vomiting or diarrhoea
Dizziness
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