COVID - Induction Health Screening Employee detailsFull name Employee D.O.B Email Phone Employee home address Have you returned from overseas or a cruise in the last 14 days? No Yes, provide detailsbelow and ensure youself-quarantine for 14 days after entering Australia.Details: Have you been in close contact with someone who has tested positive or had COVID-19 in the last 14 days? No Yes, provide detailsbelow and ensure you self-quarantine for 14 days after the last contact with an infectious case. Details: Have you, in the last 14 days, been in a COVID-19 hotspot as defined by the Chief Health Officer and published on the Qld Government website? No Yes, provide details below and ensure you self-quarantine for 14 days after leaving the designated hotspot. Details: Do you have, or have you had a fever, cough, sore throat, shortness of breath or other cold/flu-like symptoms in the last 72 hours? No, I am healthy and fit for work. Yes. Immediately seek medical advice and isolate immediately.Have you tested positive for COVID-19, or are you awaiting results of a COVID-19 test? No YesIf yes, have at least 10 days passed since the onset of symptoms and have you been free of all symptoms for the past 72 hours? Yes - Provide evidence of completed isolation. No. lmmediately seek medical advice and isolate immediately.Please provide details of your work history and accommodation details(locations and dates) for the 14 days prior to arriving at this workplace:Work history: Accommodation history: Employee declaration (employee to complete) If you ticked "Yes" to any of the questions above, please immediately seek advice from your If you ticked "No" for all questions above, please complete the declaration below: I, confirm I am fit and healthy to commence work at the aforementioned workplace.Signature Sign Here Date Last Update: 04/09/2020 Version: 2 Authorised: Troy MarlandUncontrolled if printed. Please check current status against document registerSubmit Form
