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?
Have visited, lived or worked at a location with a recognised outbreak or visited a known exposure site in the past 14 days?
Have you had CLOSE* or CASUAL** contact with a confirmed case of COVID-19?
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?
Are you a health or aged care worker with recent onset of the COVID-19 symptoms?
Are you a resident of an aged care facility?
*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?
Have you been released from hotel quarantine in the last 14 days?
Have you had COVID-19?
If yes what was the test date?:
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?
What is your temperature? (please see the reception staff member to have this taken)