Resident Pre-Visitation Booking Request

Resident Pre-Visitation Booking Request
Please be aware that all Visitors must: (Please be aware visitor restrictions are in place. Read here:
1. Pre-book using this booking system
  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 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.
Click here for Current Exposure Sites
YOU ARE NOT SAFE TO VISIT

Mistake? Click here to Restart Booking Form
Resident First and Last Name *
First and Last Name
Visitor First and Last Name *
First and Last Name
Telephone *
Email
Suburb *
State *
Please note that all visitaton must be pre-approved and our visiting hours are:
Monday - Friday (9:00am - 5:00pm) Saturday and Sunday (11:00am - 3:00pm)

Any afterhours visitation requests, must be pre-approved and you will be contacted.
I would like to visit on: *

Day Month Year
Date
Time Minutes AM/PM Option
Reason for my Visit: *
Please Select Reason
1. Do you (Visitor) - understand the precautions you should be observing? such as: You must be well to visit, 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. *

Yes No
2. 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? *

Yes No
3. Are all people in your household healthy or social circle well and do you declare you are safe and healthy to visit? *

Yes No
4. Do you (Visitor) understand that you need to notify us if you become unwell after the visit? *

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

Yes No
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 *

Yes No
7. Do you have a current Victorian Travel Permit?

Yes Not Applicable (Resident in State of Victoria)
Q8 - List Details:
Should be Empty:

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Resident Pre-Visitation Booking Request

Please be aware that all Visitors must: (Please be aware visitor restrictions are in place. Read here:

YOU ARE NOT SAFE TO VISIT

Mistake? Click here to Restart Booking Form