CovidSafe Declaration

Name *

First Name

Last Name

Have you experienced the following within the last 14 days: *

Fever, cough, runny nose, shortness of breath & other symptoms

Yes

No

Have you visited any of the Tier 1 locations listed during the date and time indicated? *

Tier-1 locations are the Covid Exposure sites: https://www.dhhs.vic.gov.au/case-locations-and-outbreaks-covid-19#case-alerts--public-exposure-sites

Yes

No

Have you been tested for Covid-19 within the last 14 days? *

Yes

No

Have you recently returned from overseas travel in the last 14 days? *

Yes

No

Have you recently returned from interstate travel in the last 14 days? *

Yes

No

Have you been in contact with a person confirmed sick with COVID-19? *

Yes

No

Do you have any health issues that may affect another person in this workshop? *

Yes

No