Covid-19 Pre Return to Work Questionnaire for Employees

This form will take approximately five minutes to complete

Please watch RSG’s COVID Housekeeping Video before completing the form:

 

Employees must complete this questionnaire at least 3 days prior to returning to work. If you indicate to us you have symptoms of COVID-19, or if you have been abroad in the last 14 days (with the exception to Northern Ireland), in accordance with Government guidance, you will be required to seek a professional medical assessment before being permitted to return to work.
DD/MM/YYYY
If YES, continue to self-isolate, i.e., stay indoors and completely avoid contact with other people, including others in your household
If YES, continue to self-isolate, i.e., stay indoors and completely avoid contact with other people, including others in your household
If YES, follow and implement the advice available at https://www2.hse.ie/conditions/covid19/contact-tracing/close-contact/
If YES, follow and implement the advice issued from the Department of the Taoiseach available at https://www.gov.ie/en/publication/77952-government-advice-on-international-travel/#passengers-arriving-into-ireland-from-overseas
If YES to any of the above, please self-isolate and contact your GP for advice.
If YES, continue to follow advice received from your GP or HSE.
If YES, continue to follow advice received from your GP or HSE.