COVID-19 Pre-return to work

    Safe Pass COVID-19 Pre-return to Work Declaration.

    This form can only be complete between 3 and 7 days before your course date

    In the interests of safety of the people attending the Safe Pass course, their families and the community, We ask that you complete the following questionnaire /self-declaration. Your co-operation and support are appreciated.
    If YES is the answer to any of Questions below, then you are strongly advised to seek medical advice and unfortunately you cannot attend safe pass training at this time.

    Please select the date you are scheduled to attend Safe Pass training below (required)

    Please answer all the questions below

    Question:
    Do you have symptoms of cough, fever, high temperature, sore throat, runny nose, breathlessness or flu like symptoms now or in the past 14 days?

    Question:
    Have you been diagnosed with confirmed or suspected COVID-19 infection in the last 14 days?

    Question:
    Are you a close contact of a person who is a confirmed or suspected case of COVID-19 in the past 14 days (i.e. less than 2m for more than 15 minutes accumulative in 1 day)?

    Question:
    Have you been advised by a doctor to self-isolate at this time?

    Question:
    Have you been advised by a doctor to cocoon at this time?

    I declare that the information I have provided in this form is accurate to the best of my knowledge. If you develop any of the above symptoms before attending the course or have reason to suspect you have had close contact with an Covid-19 infected person, then you are to stay at home, inform us and to call your doctor.

    Submit this declaration