Track and Trace | Lehane Rock School

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Covid-19 Health Declaration

How are you feeling today?

Information is gathered for track and trace purposes

First Name

Last Name

I do not currently have a fever and have not in the last 14 days

I am not experiencing COVID symptoms: fever, cough, sore throat etc

I haven’t been in close contact with a Covid-19 patient in the last 14 days

I am not currently required to quarantine in line with travel guidelines or other government restrictions

Initials

Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

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