Covid-19 Contact Tracing & Health Screening Form

Covid-19 Contact Tracing & Health Screening Form

You must complete this form as soon as you arrive at the pool
This form is to be completed when you arrive at the pool and not prior to attending. This is because we need an accurate record for contact tracing purposes

I have arrived at the poolI'm not currently at the pool
STOP.... do not complete the form if you're not at the pool right now.

You must only complete the form when you arrive at the pool. This is because we need an accurate record for contact tracing purposes.
Pool Location*

Berkeley Vale Private HospitalBrisbane Waters Private HospitalWoy Woy Public HospitalWyong Public Hospital

Covid-19 Contact Tracing Information
Type of attendee*

Parent and/or Carer of a participant attending a session at CrocStarsCrocStars Staff Member
Date

DayMonthYear
Date
Full Name of Parent/Carer or CrocStars Staff Member*
Email*
example@example.com
Mobile Number*
Time you entered the facility*
Enter the predicted time you will exit the facility
Time Out (Enter the predicted time you will exit the facility)*
Enter the predicted time you will exit the facility

Covid-19 Contact Tracing Information