2022, School House Residence Student Returning Information and Wellness Declaration

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This form is to be completed by parents of yr 9-11 students and parents and/or Y12 & 13 students on the day of returning to School House after any overnight leave. Please ensure that the details you provide in this Wellness Declaration form are accurate, thank you.

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Last Name *

First Name *

Year Level - mark only one oval *

Year 9

Year 10

Year 11

Year 12

Year 13

Who is filling this form? *

Wellness Declaration

This must be accurate, thank you. On arrival at the hostel - staff will check the Wellness declaration. Once this has been verified the student will be able to enter the hostel.

Please tick any of the following main unwell symptoms - that apply to the student, in the last 7 days. *

This must be accurate, thank you. On arrival at the hostel - staff will check the Wellness declaration. Once this has been verified the student will be able to enter the hostel.

Have a new or worsening cough

Has a high temperature (38 degrees C+)

Has a shortness of breath

Has a sore throat

Has sneezing and/or has a runny nose

Has a temporary loss of smell or taste

Has none of the above symptoms

Obligatorisk

If you ticked more than 2 of the 'main' symptoms - please explain further here, thank you.

Please tick any of the following 'other' unwell symptoms - that apply to the student in the last 7 days. *

Has diarrhea

Has vomiting

Lower back pain

Abdominal pain

Muscle aches

Headache

Joint pain

Chest pain

Has none of the above symptoms

Obligatorisk

If you ticked any of 8 'other' unwell symptoms boxes - please explain further here, thank you. *

Has the student been exposed to anyone showing signs of illness for the last 7 days? *

Mark only one oval.

Yes (this student will need to be monitored closely)

Obligatorisk

The student's temperature is: *

Mark only one oval.

Normal Temperature - around 37ºC (you are able to return to the hostel)

38–38.9°C – mild fever (If this is accompanied by 1 other 'main' symptom please stay home to isolate and get a Covid test)

39–39.9°C – high fever (Stay at home, isolate and get a Covid test)

Obligatorisk

The student is returning after isolating at home because: *

Mark only one oval.

The vaccinated student was unwell and had a negative covid test and is returning to school.

The unvaccinated student was unwell and had a negative covid test and is returning to school.

The vaccinated student was unwell and had a positive covid test and is returning after 7 days of isolation and has had Public Health verification to return to school.

The unvaccinated student was unwell and had a positive covid test and is returning after 10 days of isolation and has had Public Health verification to return to school.

The vaccinated student was a close contact and had a positive covid test and is returning after 7 days of isolation and has had Public Health verification to return to school.

The unvaccinated student was a close contact and had a positive covid test and is returning after 10 days of isolation and has had Public Health verification to return to school.

The vaccinated student was a close contact and had a negative covid test and is returning to school.

The unvaccinated student was a close contact and had a negative covid test and in returning to school

The unvaccinated student was a casual plus contact and had a positive covid test and is returning after 7 days of isolation and has had Public Health verification to return to school.

The unvaccinated student was a casual plus contact and had a negative covid test and is returning.

The question does not apply as the student has not been isolating.

Obligatorisk

I declare that all of the above details are correct. This is your electronic signature. *

Mark only one oval.

Yes I agree all of the above details are correct.

Obligatorisk

In the event that there is a change in position or any of the above symptoms are present, changes will be notified to the Director of Boarding immediately. *

Mark only one oval.

Yes.

Obligatorisk

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