covid19

COVID-19 Personal Health Declaration

You must provide a daily Personal Health Declaration (PHD) prior to coming into SafeNet to ensure the safety of all our workers, visitors and the wider community.

Step 1 of 3

Your Details
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Email*

COVID-19 Health Declaration
1. Do you have any COVID-19 symptoms, such as fever, a cough, sore/scratchy throat, shortness of breath, loss of smell or loss of taste?*
2. Have you had close contact with a confirmed case of COVID-19 in the past 24 hours?*
3. Have you shared a closed space for 2 hours or more with a person with a suspected or confirmed case of COVID-19 in the last 24 hours?*
4. Have you been to a known hotspot?*
5. Have you travelled to any known hotspots within Australia in the past 14 days?*
6. Are you under any health direction to isolate or quarantine*

Consent*
I declare, to the best of my knowledge, the answers to the questions in this form are true and correct.
DO NOT ATTEND!*
The information provided means you are unable to attend SafeNet - Please call us to arrange an alternative plan.

COVID-19 Personal Health Declaration

Step 1 of 3

Your Details

COVID-19 Health Declaration