COVID-19 VISITOR DECLARATION (Head Office)

In the interest of protecting the health and well-being of our visiors and staff, prior to entering Orbit Homes, we are required to ask you questions related to your health and travel activities so that we can all do our best to prevent the spread of COVID-19 in our community.

Full Name

Mobile

Postcode

Appointment With

Appointment Type

State

In the last 30 days, have you had any of the following symptoms: Fever, Chills or sweats, Sore throat, Runny nose, Nausea, Fatigue, Shortness of breath or Loss of sense of smell?

Yes

Have you returned from overseas travel in the past 30 days?

Yes

Have you had a test for Coronavirus without a negative outcome?

Yes

Have you had any known close contact with anyone who would answer yes to the above questions?

Yes

I understand that this information will be handled in accordance with Orbit Homes’ privacy policy and it will be supplied to the government if required for COVID-19 contact tracing purposes. in-line with the Victorian Government’s COVID-19 restrictions, I accept these terms and declare the truthfulness of the statements above.

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COVID-19 VISITOR DECLARATION (Head Office)