COVID-19 SCREENING

 

PLEASE READ BELOW AND FILL OUT THE Decleration FORM at the end 48 HOURS PRIOR TO ATTENDING A GAME HOSTED AT NORTH HARBOUR STADIUM BY NORTH HARBOUR RUGBY UNION

 

  1. Have you had any of the following symptoms in the 14 days prior to attendance/joining the team?
    • Fever or chills
    • Cough
    • Shortness of breath or difficulty breathing
    • Sore throat
    • Sneezing and runny nose
    • Loss of sense of smell
    • Other - please specify

If yes to any of the above, please DO NOT enter the stadium.

You will need to contact your Doctor or GP via phone/text for advice on COVID-19

 

  1. Have you had COVID-19? 

If yes, please DO NOT enter the stadium. You will need to contact your Doctor or GP via phone/text for advice on COVID-19

 

  1. Are you awaiting results from being tested for COVID-19? 

If yes, please DO NOT enter the stadium. You will need to contact your Doctor or GP via phone/text for advice on COVID-19

 

  1. Have you been in close contact with any confirmed or suspected COVID-19 case in the past 14 days? 

If yes, please DO NOT enter the stadium. You will need to contact your Doctor or GP via phone/text for advice on COVID-19

 

  1. Have you been in close contact with anyone who has been unwell in the 14 days prior to attendance/joining the team? 

If yes, please DO NOT enter the stadium. You will need to contact your Doctor or GP via phone/text for advice on COVID-19

 

  1. Have you returned, or been in close contact with anyone else, who has returned from overseas and who has been released from quarantine within the past 14 days ? 

If yes, please DO NOT enter the stadium. You will need to contact your Doctor or GP via phone/text for advice on COVID-19

 

  1. Have you been in close contact with anyone who works at the border (e.g. airport/maritime port, customs and immigration staff, or staff in a managed isolation facility) within the last 14 days? 

If yes, please DO NOT enter the stadium. You will need to contact your Doctor or GP via phone/text for advice on COVID-19

 

  1. Do you or does anyone in your family/whanau have a chronic medical condition or concern? 

If yes, please DO NOT enter the stadium.

 

 

  1. Are you or is anyone in your family/whanau immunocompromised in any way by illness or treatment? 

If yes, please DO NOT enter the stadium.

 

     Declaration

THIS INFORMATION IS BEING COLLECTED TO ASSIST IN THE MANAGEMENT OF THE COVID-19 PANDEMIC AS IT RELATES TO ELIMINATING RISK OF TRANSMISSION OR MINIMISING TO AN AGREED ACCEPTABLE LEVEL DURING THE 2020 NZR DOMESTIC COMPETITIONS. WE WILL NOT USE IT FOR ANY OTHER REASON.

By agreeing to the following statements, I agree to abide by all health and safety and COVID-19 risk management protocols, wherever possible, including: hygiene and cleaning practices contact tracing requirements staying at home if you are unwell and contacting your Doctor immediately.

 

Verify that you are a human, please choose cherry

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