Westbury Swim School

Pre- Swim Personal Assessment Declaration

    Please tick as follows *




    This form must be completed and submitted before each swimming lesson

    Should you answer YES to any of questions 1-5, you should NOT attend Westbury Swim School for swimming lessons

    For question 6, the latest government travel advice applies

    Before you resume swimming lessons, you should follow appropriate medical advice and guidelines

    1.

    Have you been identified by Public Health as a close contact of a confirmed case of Covid-19 in the past 14 days? *

    2.

    Have you been diagnosed with confirmed or suspected Covid-19 infection in the past 14 days? *

    3.

    Have you been advised by a doctor to self-isolate at this time? *

    4.

    Are you or any of your household contacts awaiting the results of a Covid-19 test? *

    5.

    Are you feeling unwell, have felt unwell in the past 48 hours or have any common symptoms of Covid-19 including? *

    • Fever or High Temperature

    • A New Continuous Cough

    • Unexplained Breathing Difficulties or shortness of breath

    • Loss or change to your sense of smell or taste

    6.

    Are you currently required to self isolate/restrict movement due to recent overseas travel? *

    Declaration

    Acknowledgement *

    Please prove you are human by selecting the Cup.
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