This form has recently chanced please read all questions , You must fill this COVID-19 Personal Screening out on the day your session is booked, before 1pm week days and at lease 1 hour before your session on weekends or the booking will be cancelled


If you or any one in your household including the person your booking for are waiting on coronavirus test results , self isolating or have been send home from work or school to isolate please do not attend the track



As parents / guardians you are filling this screening on behalf of the riders whom you a responsible for please read the below and answer carefully, this is not only to protect yourself but those around you on the sessions

Todays Date- this should be filled out on the day of the session ,not before

Are you/rider(s) Or any one in your household currently diagnosed with or believe you may have COVID-19?yesno

Do you have a shielding letter/ advice for self isolation, If yes please do not attend the facilityyesno

Have you/rider(s) any one in your household had any of these symptoms of COVID-19 in the past 14 days? yesno

High temperature (fever)? yesno

A new continuous cough? yesno

New unexplained shortness of breath? yesno

Sneezing or runny nose? yesno

A sore throat? /Loss of smell? yesno

Have you/rider(s) been in contact with a COVID-19 confirmed or suspect case in the previous 14 days?yesno

Provided direct care for COVID-19 patients in the past 14 days?yesno

Visited or stayed in a closed environment with anyone with COVID-19 in the past 14 days? This includes any business premises that have recently closedyesno

Traveled together with COVID-19 patient in any kind of conveyance in the past 14 days?yesno

Arrived in Northern Ireland from another country not on the ''green'' list in NI or ROI(not including UK and Ireland) in the last 14 days –this includes citizens traveling home?yesno

If you have answered YES to any of these questions above you should stay at home and inform your medical practitioner

I agree that i am currently following local government guidelines and can attend the track - If you are on localized lockdown you may not legally be allowed to attend please ensure this is okyesno

I can confirm i have answered these questions truthfully to the best of my knowledge yesno

if any of the above changes 24hours before the booked session you must inform Lisburn BMX Club