Pre-Site Visit Risk Tool

Pre-Site Visit Risk Tool
Please be aware that all Visitors must:
1. Complete this tool to ensure you are safe to visit.
2. We will confirm a suitable time for you to visit and carry out the necessary work/tasks intended.
3. Please be aware if deemed safe to visit a health declaration screening will be undertaken on the day of your visit. Evidence of your COVID-19 vaccination is a requirement to provide care or services.
4. You will be required to undertake a Rapid Antigen Test (RAT) prior to entry. Please allow 15 minutes for the RAT result before entering our facility.
Business Name
Full Name *
First and Last Name
Telephone *
Reason for Visit: *
Proposed Date of Visit: *

Day Month Year
Date
Signature *

Clear
Upload your Rapid Antigen Test Result

Cancel of
Upload your Immunisation History Statement or COVID-19 Digital Certificate

Ensure that your Document States all three doses.
Cancel of
1. Have you been fully vaccinated for COVID-19, had Dose #1, Dose #2 or Boosted OR do you have a Medical Exemption? *

Yes No
2. I will/have provided evidence of the above prior to or when visiting *

Yes No
3. Do you understand the precautions you should be observing? such as:Avoiding people who have been overseas in the last 7 days, avoiding people who have been isolated in the last 7 days, avoiding people who have cough, cold or other respiratory symptoms or COVID symptoms, maintaining social distancing of at least 1.5 meters, avoiding close contact and wearing a mask, group, abiding by the current state restrictions/rules *

Yes No
4. Are all people in your household or workplace healthy and/or social circle well? and Do you declare you are safe and healthy to visit? *

Yes No
5. Do you understand that you need to notify us if you become unwell after the visit? *

Yes No
6. Have you been exposed recently (last 14 days - unvaccinated, 7 days - vaccinated) to a suspect or positive case or been asked to self-isolate or await a COVID test result? *

Yes No
7. Do you work across multiple sites/organsations or visit other aged care homes/hospitals that have been exposed to COVID-19 cases? *

Yes No
Q7a - Please list details
YOU ARE NOT SAFE TO VISIT

Mistake? Click here to Restart the Pre-Risk Tool
If you answer NO to Question 1- 5 this means High Risk and No Entry.
If you answer YES to Question 6 this means High Risk and possible No Entry.
Should be Empty:

Pre-Site Visit Risk Tool

YOU ARE NOT SAFE TO VISIT

Mistake? Click here to Restart the Pre-Risk Tool