Covid-19 Health Declaration

How are you feeling today?

Due to the outbreak of Coronavirus (COVID-19) and in line with local government directives to mitigate the spread of COVID-19, and having regard for your health and safety and that of your colleagues and our guests, we request for your cooperation in taking precautionary measures to help prevent the spread of COVID-19.

Please complete this declaration before commencing work and provide it to your shift supervisor or hotel contact. This is to be completed every day you attend the Hotel or for every shift.  This form will be kept for a period of 28 days from the date it is completed and, unless required to be kept for a purpose set out below, will then be securely destroyed.

This form has three parts. Part A involves a self-declaration of your health, Part B requires a confirmation and signature Part C is the identification of Close Contacts and Part D is the areas you have visited in the hotel.

Part A: Declaration of health

In providing the information in Part A of this form, you consent to our collection, use, processing, transfer, and/or disclosure of your personal data, including any sensitive data, in accordance with all applicable laws for the purposes of:


  • monitoring, evaluating, and responding to the COVID-19 outbreak;

  • providing accommodation and services in the Hotel having regard to Public Health Agency guidelines, and, to the extent necessary, for the safety of guests, staff and contractors;

  • taking precautions and actions to provide a safe workplace; 

  • providing information to Public Health Agencies, medical personnel and any other relevant governmental agency.  

Are you currently required to be in isolation because you have been diagnosed with coronavirus (COVID-19)?
Are you required to quarantine yourself due to your travel history (including interstate travel) or due to your place of residence?
Are you required to quarantine yourself because you have been in close contact with someone who is diagnosed with Covid-19?

If you answered YES to any of the above questions you must not attend work / the Hotel until advised by health officials that you are released from isolation or until your 14-day quarantine period is complete so long as you have not developed symptoms during such period. You may be required to provide a medical certificate to confirm you are fit to return to work.


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


Are you experiencing these symptoms?

Fever (If your temperature is at 37.5°C or above)
Shortness of breath
Runny nose
Loss of sense of smell
Sore throat

If your answer is “Yes” to any of these questions, do not enter the workplace, immediately notify your manager, avoid being in close proximity to anyone and immediately return home.  Please also refer to for further advice and get tested for COVID-19.

If you become ill with any COVID-19 symptoms including while you are at work or otherwise at the Hotel’s premises, please immediately inform your Manager (by phone), avoid being in close proximity to anyone and follow the advice of the relevant Public Health Agencies.

Part B: Confirmation

By signing this form, you confirm that the information provided by you is correct and accurate.

I give express permission for the information in this form to be collected and kept for the purpose of record keeping and for the purposes set out in Part A above for at least the next 28 days.
I have been explained my responsibilities in regards to the sites COVID safe plan and am confident in my ability to facilitate.

Part C: Close Contacts

Notification is required for contact tracing should you share accommodation or travel to or from work via private transport with another employee working at the hotel.

Do you currently reside with or share private transport with another hotel employee
Provide details of areas visited whilst on site:

Thanks you! Now go wash you hands...