KDHS Accommodation Sign-In Form : Kyabram District Health Services Intranet

Name *

First

Last

Contact Number *

Accommodation *

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

If you answered YES to the above question do not enter the building and contact the grade 5 on 58570219 for further advice and instructions.

Have you visited an exposure site listed on the Department of Health website? *

If you answered YES to the above question do not enter the building and contact the grade 5 on 58570219 for further advice and instructions.

Do you have any symptoms of COVID-19 (fever/chills, sore throat, cough, runny nose, loss of smell or taste)? *

If you answered YES to the above question do not enter the building and contact the grade 5 on 58570219 for further advice and instructions.

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

If you answered YES to the above question do not enter the building and contact the grade 5 on 58570219 for further advice and instructions.

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 do not enter the building and contact the grade 5 on 58570219 for further advice and instructions.

Is your temperature under 37.5 degrees? *

If you answered NO to the above question do not enter the building and contact the grade 5 on 58570219 for further advice and instructions.