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Coronavirus (Covid-19) Health Questionnaire

The World Health Organisation declared the Coronavirus (COVID-19) a Global Health Emergency on the 30th January 2020 and Pandemic on 11th March 2020. Waterlife Swim School will take reasonable, proportionate steps in accordance with published guidance, to respond to the current (known) risks associated with the virus.

It is important that any person who enters any part of the pool or venue is medically and physically fit and is not a danger to themselves or the health and safety of others. If you are not sure, you should seek medical guidance from NHS 111.

Please fill in and submit the form below.

Your Name *

Name of Child (young swimmer) *

Contact Number *

Email *

Have you travelled internationally and returned to the UK in the past 14 days from a country outside of the government’s current common travel area? *

Yes
No

Have you knowingly been in contact with any person who has returned from a country outside of the government’s current common travel area in the last 14 days? *

Yes
No

Have you been exposed to a confirmed case of Coronavirus? *

Yes
No

Do you have any of the following symptoms? (please tick all that apply) *

A high temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature)
A new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
A loss or change to your sense of smell or taste – this means you’ve noticed you cannot smell or taste anything, or things smell or taste different to normal
None of the above

I confirm that I will immediately inform Waterlife Swim School if any of the circumstances above change *

Yes
No

I warrant that, to my knowledge, I am medically and physically fit and able to undertake and participate in swim school activities and will not be a danger to myself or to the health and safety of others. *

Yes
No

I understand that while at the venue, participating in swim school activities (and before and after swimming), I must ensure I undertake and comply with social distancing and exemplary hygiene measures. *

Yes
No

I acknowledge that I undertake all activities at my own risk and the swim school have not and cannot make any representation or guarantee that attending the venue or participating in swimming is free from risk. *

Yes
No

I confirm that all the information I have given on this form is correct. *

Yes
No

Signed *

Date (dd/mm/yyyy) *

If you are displaying symptoms of Covid-19 or do not meet the travel/contact criteria required as declared above then:

Access to the pool is DENIED
The UK Government advises that you must self-isolate for 14 days to help limit the spread of germs
If you have any concerns about your health and COVID-19, please call NHS 111
If you are tested for COVID-19 and it is confirmed, you must immediately advise Waterlife Swim School.

Anyone who visits another country during the whole of the 12 week course must not attend swimming lessons if quarantine is in force on your return or you have been required to self isolate by the government.

Coronavirus (Covid-19) Health Questionnaire was last modified: October 5th, 2020 by admin

Permanent link to this article: http://www.waterlifeswimschool.com/coronavirus-covid-19-health-questionnaire.htm