Attendance Registration Test page

Name (required)

I am a (required)
PatientCarer accompanying patientProfessional VisitorDigestive Health Staff

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?
YesNo

Have visited, lived or worked at a location with a recognised outbreak or visited a known exposure site in the past 14 days?
YesNo

Have you had CLOSE* or CASUAL** contact with a confirmed case of COVID-19?
CloseCasualNo

Have you had contact with someone who has been in quarantine as a close contact of someone with COVID-19 in the past 14 days?
YesNo

Are you a health or aged care worker with recent onset of the COVID-19 symptoms?
YesNo

Are you a resident of an aged care facility?
YesNo

*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 worked in or volunteered at a hotel quarantine site and/or other port of entry in the last 14 days?
YesNo

Have you been released from hotel quarantine in the last 14 days?
YesNo

Have you had COVID-19?
YesNo

If yes what was the test date?:
Date

Time

Have you travelled overseas in the past 14 days?
YesNo

If Yes:
Where

Do you have any of the following symptoms Cough, Sore throat, Shortness of breath, Chills, Recent loss of sense of smell or taste, any other respiratory symptoms?

YesNo

If Yes, please list your symptoms here:

What is your temperature? (please see the reception staff member to have this taken)

Staff & Professional visitors must answer the below question
I have received at least one dose of a COVID-19 vaccine, or have a booking to receive the first dose of a COVID-19 vaccine before 29 October 2021 OR can provide proof of a medical exemption
YesNo