Melbourne Metro - Daily Health Declaration

Daily Health Declaration
To prevent the spread of COVID-19 and reduce the potential risk of exposure, your participation is important to help us take precautionary measures to protect you and everyone in this business. Thank you for your time.
Date*
DayMonthYear
DateHourMinutesAM/PM Option
Name*
Phone Number*
Temperature (taken from attached thermometer)*
Have you had close contact with or cared for someone diagnosed with COVID-19 within the last 7 days*
YesNo
Have you experienced any cold or flu-like symptoms in the last 7 days (to include fever, cough, sore throat, respiratory illness, difficulty breathing)?*
YesNo
Signature*
Clear
Should be Empty: