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nose, breathlessness, or flu like symptoms now, or in the past 14 days?
Yes/No
o Have you been diagnosed with a confirmed virus infection or of having a
suspected Virus infection in the last 14 days? Yes/No

o Have you been in close contact with a person who is either a confirmed or
suspected case of contracting a Virus in the past 14 days (i.e. within 2
metres for more than 15 minutes accumulative in 1 day)? Yes/No

o Have you been advised by a Doctor to self-isolate at this time? Yes/No
o Have you been advised by a Doctor to cocoon at this time? Yes/No.

Employees must:
o Complete this form before they return to work.
o Inform their line manager if there are any other circumstances relating to a
Virus. (the employee must include information which may be needed to be
disclosed to allow their safe return to work in the interests of Public Health
Safety).
o Self-isolate at home and contact their GP or the GP out of hour’s services for
their
area promptly for further advice if they have any Virus symptoms.
Stay out of work until all symptoms have cleared following self-isolation.
Participate in any induction training provided on their return to the work.

When employees return to work, they are required to request any updates on:
o What an employee should do if they develop symptoms of a Virus
o Details of how the workplace is organised to address the risk from Viruses
o An outline of the Virus response plan
o Arrange for the putting in place of the necessary controls identified in the
risk assessment to prevent the spread of Viruses in the workplace.

7.11 Dealing with a Suspected Case of a Virus in the Workplace
In line with HSE guidelines, employees should not attend work if displaying any symptoms of a Virus.
In the event that a suspected case of a Virus is reported during the course of work the following are
the steps outlined by the HSE as to how to respond:

• The employee must contact their line manager.
• The employee must proceed to the designated isolation area, keeping at least 2 metres away
from other employees and also making sure that colleagues maintain a distance of at least 2
metres at all times from them.
• If face masks are available in the isolation area, the employee is to wear the face mask
provided, particularly in a common area with colleagues or while exiting the premises.
• In the event that the employee is able to go home they should do so after discussion with their
line manager. When the employee arrives home, they must call their doctor or out of hours
GP service or the HSE and follow medical advice which could include continuing self-isolation at home.
• If the employee is unable to go home, they must contact their doctor or out of hours GP service
or the HSE and follow medical advice. As long as the employee remains in work, they must
avoid contacting or touching colleagues, surfaces, and objects.
• While leaving or waiting to leave their workplace, it is necessary for employees to cover their

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