To ensure the Safety & Health of all people interacting with Sli Nua Careers locations, visitors and contractors must complete this declaration form prior to entering our sites. If you indicate to us you have symptoms of COVID-19 OR you have been abroad in the last 14 days with exception to Northern Ireland you should not be in the premises. Where this is the case, you are prohibited from entering the premises and advised to seek professional medical help/assistance.

Name (required)

Home Address

Email (required)

Date of appointment

Location of appointment

Do you believe that you may currently have COVID-19?
YesNo

Please tick if you had any of the following symptoms or possible indicators of COVID-19 in the past 14 days:
High temperature (i.e. over 37.5 degrees Celsius)New unexplained shortness of breathA new continuous coughLoss of sense of smell, of taste or distortion of tasteDid you consult a doctor or other medical practitioner?Have you been in contact with someone who has visited an affected region in the past 14 days?

If you have answered YES to any of these questions you should stay at home and contact your GP by phone for further advice. If you have answered NO to all of the above questions you may attend at Sli Nua Careers for your appointment.

When you complete this form, and press submit below, it automatically syncs to Sli Nua Careers and to you. Your information will be stored securely by Sli Nua Careers for three weeks, at which point it will be destroyed as it is no longer required for the purpose for which it was gathered (namely to support measures to prevent the spread of COVID-19).

When on site, please adhere to our on-site standard processes/procedures regarding infection control, i.e. hand washing/hand sanitising and general coughing/sneezing etiquette?

Data Protection Notice
Your personal data is being collected on this form in order to help prevent the spread of COVID-19 in our premises. Your personal data is being processed in accordance with Article 9(2)(i) of the General Data Protection Regulation, and Section 53 of the Data Protection Act 2018. The information you provide on this form will not be used for any other purpose, and will be strictly confidential. Sli Nua Careers Data Controllers for the information on this form. If you have any queries in relation to this, contact Niamh McHugh, COVID-19 Response Officer, Sli Nua Careers, admin@slinuacareers.com or by phone +353 94 95 42965.

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