Resident Visitation Booking Request

Resident Visitation Booking Request
Please be aware that all Visitors must: (Please be aware visitor restrictions are in place. No Visitation unless a End-of-Life visit has been approved.)
1. Pre-book using this booking system (end-of-life bookings only until Wednesday 17th February)
  We will continue to work in partnership with our families but we ask that you respect the guidelines, directions and policies we have in place.
2. Declare they are well to visit and adhere to visitation rules
3. All visits to take place in the resident's room only or an approved designated space.
4. It is still advised that visitors have a influenza vaccine and provide evidence of their 2020 vaccine.
5. All visitors entry and exit times will be recorded by the reception team during office hours (Monday - Friday: 9:00am to 5:00pm, Weekend: 11:00am to 3:00pm) It is our preference for all visitors to visit during office hours.
6. All after hours visitors must have their request approved by the Director of Care in advance.
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Resident Name *

First Name Last Name
Visitor Name *

First Name Last Name
Address *

Street Address

Subrub State / Province

Post Code
Telephone *
Email
I would like to visit on:
Afterhours Visit:
Please note this must be approved 24-48 hours prior to visit
Afterhours Time Request (Please State)
Date (Weekday)

Day Month Year
Date
Time (Weekday)
Please detail what time you will be visiting:
Date (Weekend)

Day Month Year
Date
Time (Weekend)
Please detail what time you will be visiting:

Pre Visit - Risk Management *

YES

1. Do you (Guest) - understand the precautions you should be observing? such as:

- Avoiding people who have been overseas in the last 14 days.

- Avoiding people who have been isolated in the last 14 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.

- Avoiding being in a large group,

- Abiding by the current state restrictions/rules.

2. Are all people in your household healthy or social circle well?

3. Do you declare you are safe and healthy to visit?

4. Does the Guest understand they need to notify us if they become unwell after the visit?

5. Do you work across multiple sites/organsations or visit other aged care homes/hospitals that have been exposed to COVID-19 cases?

6. Have you lived or visited or been in contact with any person or persons from a Public Exposed site in Victoria or Red/Orange zones from other states?
(Please be aware that when travelling to Victoria from other states a Travel Permit is required or an exemption - please be prepared to offer any evidence to us when requested). https://www.dhhs.vic.gov.au/case-locations-and-outbreaks

7. Have you been exposed recently (last 14 days) to a suspect or positive case or been asked to self-quarantine or await a COVID test result?

8. Do you have a current Victorian Travel Permit?

Q8 - List Details:
Should be Empty:

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