Coronavirus disease (COVID-19):

Coronavirus disease (COVID-19) is a current health issue. We are regularly monitoring the most up-to-date information provided by the Victorian Department of Health and Human Services. Find out more.

COVID-19 attendance register

You must complete this form before entering the venue to help us provide a safe place and to help prevent the spread of COVID-19. 

Declaration

Please note that if any of the following health screen questions apply to you or anyone listed on this form you must NOT enter any Council venue, service or facility until cleared by DHHS. If you have symptoms, please get tested for COVID-19 immediately. You can find more information at: https://www.dhhs.vic.gov.au/getting-tested

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I am not experiencing flu/cold like symptoms such as fever, chills, cough, sore throat, shortness of breath, runny nose or loss of sense of smell

I have not returned or have not been in contact with someone who has returned from overseas in the past 14 days

I am not COVID positive

I am not waiting for COVID test results or do not live with someone awaiting results

Your privacy

Your personal and health information requested on this form is being collected to help Council provide a safe workplace and to help prevent the spread of COVID-19. It may be disclosed to or shared with other Council staff, the Department of Health and Human Services or as required by the Victorian Chief Health Officer to assist with contact tracing.

For more information on Council's privacy policy, you can email Council's privacy officer at privacy@gleneira.vic.gov.au or view Council's Privacy Policy.