Daily Staff Attestation – Sheridan : Kyabram District Health Services Intranet

Staff Member Name: *

I am well and free of any COVID-19 symptoms? *

Please contact your supervisor immediately and do not enter the building.

Have you been a primary or secondary close contact of a COVID-19 positive case in the last 14 days? *

Please contact your supervisor immediately and do not enter the building.

Have you been overseas in the last 14 days? *

Please contact your supervisor immediately and do not enter the building.

Have you worked in any other workplace in the last 14 days? *

If you answered YES to the above question is your manager aware.

Are you waiting for test results from a COVID-19 test? *

If you answered YES to the above question is your manager aware.

Have you been diagnosed with COVID-19, and have not yet been cleared by the Department of Health? *

If you answered YES to the above question is your manager aware.

Please record your temperature *