COVID-19 Visitor/Student Registration
COVID-19 Visitor/Student Registration
At Civil Safety, we concentrate our efforts on preventing the spread of the novel coronavirus (COVID-19) following the World Health Organization's COVID-19 outbreak guidelines
Please register your details
Date
Date
/
DD
/
MM
YYYY
Time
Time
:
HH
MM
AM
PM
AM/PM
Q1: Are you experiencing any cold like symptoms?
*
YES
NO
Q2: Have you travelled overseas or been in a COVID hotspot in the last 14 days?
*
YES
NO
Q3: Have you been in contact with someone with COVID-19 in the last 14 days?
*
YES
NO
What is your full name?
(To keep you informed in the event a COVID-19 positive case is detected in our premises).
What is your full name?
(To keep you informed in the event a COVID-19 positive case is detected in our premises).
*
First
Last
What is your email address?
(To contact you in the event a COVID-19 positive case is detected in our premises).
*
What is your phone number?
(To contact you in the event a COVID-19 positive case is detected in our premises).
*
Must be
10
digits.
Currently Entered:
0
digits.
Civil Safety location
*
S.E.Queensland
Moranbah
Mackay
Rockhampton
Bundaberg
Gladstone
Townsville
Cairns
Weipa
Sign n Send
*
Draw
or
Type
I understand this is a legal representation of my signature.
Clear
Full Name
I understand this is a legal representation of my signature.