COVID-19 Declaration Form

COVID-19 Declaration

Name*
First Last
Phone*
Email*
In the last 14 days, have you been in contact with a person who has tested positive to COVID-19?*
- Yes
- No
In the last 14 days, have you shown any signs or symptoms of COVID-19?*
Symptoms include but are not limited to; fever, coughing, sore throat, headaches, raised temperature or difficulty breathing.
- Yes
- No
In the last 14 days, have you visited any location with a confirmed COVID-19 case?*
Affected NSW locations can be found by visiting: https://www.nsw.gov.au/covid-19/latest-news-and-updates
- Yes
- No
Consent*
I consent to provide the information above, which I certify is accurate to the best of my knowledge.

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