MHP HEALTH CHECK FORM

Long visits (more than 15mins) must complete this Health Check before starting a shift/meeting. If you would like to get your temperature checked, please attend the Temperature Check Area.

FIRST NAME *

LAST NAME *

DATE OF SHIFT * +

SHIFT START TIME *

SHIFT END TIME *

VENUE *

HAVE YOU HAD A COVID-19 TEST AND ARE AWAITING THE RESULTS? *

ARE YOU CURRENTLY REQUIRED TO BE IN ISOLATION BECAUSE YOU HAVE BEEN DIAGNOSED WITH CORONAVIRUS (COVID-19)? *

HAVE YOU BEEN DIRECTED TO A PERIOD OF 14-DAY QUARANTINE BY THE DEPARTMENT OF HEALTH AND HUMAN SERVICES AS A RESULT OF BEING A CLOSE CONTACT OF SOMEONE WITH CORONAVIRUS (COVID-19)? *

If you answered YES to either of the above questions you should not attend work until advised by the Department of Health and Human Services that you are released from isolation or until your 14-day quarantine period is complete. Please do not enter the workplace (or you should leave the workplace immediately). Notify your manager and go home, and get tested for coronavirus (COVID-19).

If you answered NO to the above questions, proceed to the symptom checklist below.

SYMPTOMS OF COVID-19

SHORTNESS OF BREATH, SORE THROAT, FEVER OR CHILLS, COUGH, RUNNY NOSE, FATIGUE, LOSS OF SENSE OF SMELL OR LOSS OF SENSE OF TASTE

ARE YOU EXPERIENCING ANY OF THE ABOVE COLD OR FLU SYMPTOMS THAT COULD BE COVID-19? *

If you answered YES to any of the above questions you should not enter the workplace (or you should leave your workplace immediately). Notify your manager and go home, and seek medical attention.

If you answered NO to all the above questions you are cleared to start your shift. If you would like to get your temperature checked, please report to the Temperature Check Area.

If you develop symptoms, stay at home and seek further advice from the 24-hour coronavirus hotline 1800 675 398 or your general practitioner.