COVID-19 Declaration MAE KING

WHO has declared COVID-19 a public health emergency of international concern. Inline with Australia’s Health guidelines and the commitment of MAE KING to ensure the safety of our employees and contractors in a safe filming environment, we need to ask you, to truthfully answer the following questions. Depending on your responses, we reserve our right to not engage your services for current productions. Your responses to these questions will only be used for the purpose of the Homestart TVC shoot scheduled for Monday 7th September, 2020, taking place in Alberton, SA.

Everyone should complete this form or, if they are minors, have the form completed on their behalf.

Name/s*

Address:*

Contact Email:*

example@example.com

Contact Phone Number:*

Have you or anyone you immediately know had a confirmed case of COVID-19? I*

YESNO

If yes please elaborate

Have you been to a state, country or area of concern with COVID-19 anytime in the last 6 months?*

YESNO

If yes please elaborate

Do you currently have any of the typical symptoms associated with COVID-19 (runny nose, fever, sore throat or cough) or any other contagious viral or bacterial illness, OR have you had such symptoms in the last 30 days?*

YESNO

If yes please elaborate

Have you or anyone you immediately know travelled nationally or internationally in the last month (30 days)?*

YESNO

If yes please elaborate and list travel areas / countries

Have you worked on or with any other productions / projects in the last 20 days?*

YESNO

If yes please elaborate and list details including location of work

Please note while being employed, contracted or involved in a MAE KING production please practice good hygiene, including regularly & thoroughly washing and drying hands and please practice good cough etiquette, along with social distancing and following instructions of the covid safe supervisor. For more information please read the https://www.screenaustralia.gov.au/getmedia/d8ec53c2-5a19-4651-a0da-65abf0577837/COVID-Safe-Guidelines.pdf

Name

Date

Signature