KEORCA Facility Attendance Record

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For contact-tracing at KEORCA (if required by DHHS). You need to register on arrival, and again on departure. We also encourage you to also use the "COVIDSAFE" App while on premises. We take your privacy seriously, however note the information provided in this registration WILL be provided to DHHS if required for contact tracing purposes.

For families: Times must be accurate for each person. Consider individual registration if you are arriving or leaving at different times.

DO NOT attend the facility if you are unwell, have been near an individual recently deemed a "Close Contact" by DHHS, or have been at a current outbreak location where there is a risk you may be infectious.
Current outbreaks can be found here: https://www.dhhs.vic.gov.au/case-locations-and-outbreaks

Registering Individual: What is your NAME? *

I am registering: *

Family members arriving/departing at the SAME TIME as the "Registering Individual" (Leave BLANK if none)

What is the current DATE?

YYYY

What is the current TIME?

Time

Contact Number (if contact tracing is required) *

Attestation: I/we are well with no symptoms of Covid-19, NOT meant to be in isolation/quarantine, NOT a close contact of an infectious individual, NOT living outside the zone(s) permitted by DHHS to attend KEORCA and not in breach of any DHHS guidelines *

Attestation: I/we confirm we will follow DHHS guidelines, the KEORCA Covid-Safe Plan and directives of the Committee regarding Covid-Safe practices/instructions at all times while attending KEORCA *

Please follow KEORCA's COVID SAFE plan, and slow the spread of coronavirus by following the strategies below. THANK YOU!!!

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