Your Name (required)
In the last 14 days, I have only worked for MannaCare TrueFalse
In the last 14 days, I have not arrive in Australia TrueFalse
In the last 14 days, I have not visited a Tier 1 exposure site TrueFalse
In the last 14 days, I have not visited a Tier 2 exposure site TrueFalse
In the last 14 days, I have not visited a Tier 3 exposure site TrueFalse
I am not current required to self-isolate or quarantine TrueFalse
I will wear appropriate PPE when required TrueFalse
I will perform hand hygiene at appropriate times TrueFalse
I am feeling well TrueFalse
I do not have a sore throat TrueFalse
I do not have a runny nose TrueFalse
I do not have a cough TrueFalse
I do not have shortness of breath TrueFalse
I do not have a headache TrueFalse
I do not have a fever TrueFalse
I do not have muscle soreness TrueFalse
I have not had gastro symptoms in the last 48 hours TrueFalse
I do not have loss or change in sense of taste TrueFalse
I do not have loss or change in sense of smell TrueFalse
By submitting this form, I confirm that all questions have been answered truthfully and acknowledge that penalties apply for providing false information.
