COVID-19 Questionnaire

Confirm as true by ticking the box beside each statement

Covid-19 Pre Return to Work Questionnaire

Name*

Date*

I am not suffering any flu like symptoms / symptoms of Corona Virus Covid-19

I am not experiencing any difficulty in breathing / shortness of breath

I am not experiencing any fever like / temperature symptoms

I have not consulted a doctor or other medical practitioner in the last 14 days

I am feeling well health wise

I have not been around or in contact with someone who has visited an affected region in the past 14 days

I have not been around or in contact with someone with symptoms of Covid-19 in the past 14 days

There are no members of my household self-isolating

I am not in a period of self-isolation and/or cocooning under the current Health Policy rules

I am not in a high risk category

Covid-19 Awareness & Manual Handling Training

I have successfully completed the online Covid-19 Awareness for Employees Training delivered by Peninsula

I have successfully completed online Manual Handling Training delivered by Peninsula & attended practical Manual Handling Training with Gibbons Recruitment

I consent to my personal data being submitted in accordance with the Gibbons Recruitment Privacy Policy.

Contact Us

Gibbons Recruitment
13 Adelaide Road, Dublin, D02 P950, Ireland

Email: info@gibbonsrecruitment.ie
Phone: 086 040 5060

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