I am a (required)
PatientCarer accompanying patientProfessional Visitor
Approximate Length of stay (required)
less than 15 minutes30 minutes1 hour3 hoursmore than 3 hours
Date of Birth (required)
Phone number (required)
Have you had or been exposed to a person with an COVID -19 in the past 14 days?
Have you resided in or visited a known high-risk area with a cluster of COVID-19 cases?
Have you had CLOSE* or CASUAL** contact with a confirmed case of COVID-19?
*CLOSE defined as: Spending > 15 minutes face to face OR sharing a closed space > two hours with a person who is a confirmed case 48 hours before they showed symptoms or once they showed symptoms.
** CASUAL defined as: Spending < 15 minutes face to face OR sharing a closed space < two hours with a person who is a confirmed case 48 hours AND had symptoms at the time.
Have you recently been tested for COVID-19?
Have you travelled overseas in the past 14 days?
Do you have any of the following symptoms:
Shortness of breath
Recent loss of sense of smell or taste
Any other respiratory symptoms including a runny nose?