Resident Visitation Booking Request

Pre Visit - Risk Management *

	YES	NO
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. 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?
3. Are all people in your household healthy or social circle well and 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 visit 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

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