Useful Return To Work Policy

Return to Work Form

If you have symptoms of COVID-19 (common symptoms include; temperature of 38oC or above, a new persistent cough, or shortness of breath or breathing difficulties) you must not come to work.
You will need to restrict movements, including staying at home from work, if you do not have symptoms but you are;
 Living in the same household or shard accommodation with someone who has symptoms of COVID-19.
 A close contact (spending 15 minutes or more within 2 metres of a confirmed case)
 Returning to Ireland from another country (exception Green List).
 If you are self-isolating and waiting or awaiting results of a COVID-19 test.
Until further notice all employees are required to complete this declaration at least 3 days prior to commencing work. The company reserves the right to change this form at any time on HSE or other on government body advice.
Self-Declaration (to be completed by the employee)
Name: Department & Job Title:

I, hereby confirm that I have not experienced any symptoms of illness in the past 14 days, nor have I, to the best of my knowledge , been in close contact with a confirmed case of COVID-19, or do I live in the same household or shared accommodation with someone who has symptoms of COVID-19 nor have I travelled. I can confirm that I am not self-isolating or awaiting COVID-19 test results.

I understand that if any of the above changes, or I begin to experience symptoms I will alert management or HR immediately.
Signed:
Date:
Signature:

Reminder: All symptoms of illness should be reported immediately to management and normal absence procedures should always be followed. If you are experiencing symptoms, seek medical advice before returning to work.

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