Employee Covid-19 Self-Declaration

In the interests of safety of the people in our offices, their families and the community, we are asking you to carry out an antigen test and only return to the office if your test is negative.

Please read the following:

Should you answer ‘YES’ to any of these questions.

  1. You will need authorisation to enter the offices.

  2. You must email your manager immediately

If your answer is ‘NO’ email your manager confirming you have read the self-declaration.

Questions. (please read each one carefully)

1. Have you been in close contact with anyone who are confirmed with having COVID-19 virus?

2. Do you live in the same household with someone who has symptoms of COVID-19 who has been in isolation within the last 14 days?

3. Do you have any of the following typical COVID-19 symptoms; fever, high temperature, persistent coughing, or breathing difficulties / shortness of breath

4. Have you returned to the island of Ireland from another country within the last 14 days?

I confirm that I have read the above questions and I commit to advising my manager and inform them if my situation changes, (i.e. if a point in the future, I would answer “Yes” to any of the above questions).

Whilst you may feel that these points do not apply to you, this measure is there to protect others that may be more vulnerable.

Your co-operation and support are appreciated.





New Sure Life Ltd. t/a Mike Murphy Insurance is Regulated by The Central Bank of Ireland. Directors: M Murphy, T Murphy, E Murphy, F Murphy Registered in Ireland number 419321. Copyright @ Mike Murphy Insurance all rights reserved