COVID-19 Guest Declaration

Guest Declaration Form

During my stay:

I am staying in accommodation with self-contained toilet, shower and cooking facilitiesI am staying in a tent, caravan or motorhome

I acknowledge that:

I/We have not returned from overseas in the past 14 days
I/We am not required to be in self-isolation/self-quarantine
I/We have not previously been diagnosed with COVID-19
To the best of my knowledge, I/We have not been in close contact with a person who has a reported or suspected case of coronavirus (COVID-19) in the past 14 days
I/We have not been in a COVID-19 hotspot (as defined by the Chief Health Officer) in the past 14 days
I/We have not had a fever, cough, sore throat, shortness of breath or other cold/flu-like symptoms in the last 72 hours and are otherwise well

If you answer yes to any of these questions you may be referred to a local health authority or the police

Contact details:

Please provide details of all location’s visited and accommodation details for the past 14 days:

This information is for contact tracing purposes should it be required and may be shared with Victoria Police or local government health officials if requested

Please provide details of details of your next location and accommodation

This information is for contact tracing purposes should it be required and may be shared with Victoria Police or local government health officials if requested

Listed Parties

Please list all persons (adults and children) covered by this declaration:

Agreement

I/We agree to comply with all social distancing measures, good hygiene practices and park rules.
I declare that the answers I have provided above are true and accurate for myself and all the listed parties who are residing with me.