Have you travelled overseas in the past 21 days?

Yes

No

Are you currently serving a Quarantine Order (QO) or Stay-Home Notice (SHN) or Leave of Absence (LOA)?

Yes

No

Have you had contact or, been notified that you were in close contact, with a confirmed COVID-19 case within the past 14 days?

Yes

No

Do you have a household member (any age) who is on Home Quarantine Order and is currently staying in the same place of residence as yourself?

Yes

No

Do you have a household member (any age) who is currently serving Stay-Home Notice – SHN (due to overseas travel) in the same place of residence as yourself?

Yes

No

Do you have any adult member of your household (aged 18 and above) who is unwell (with fever or flu-like symptoms, cough, sore throat or a loss of the sense of smell)?

Yes

No

Are you feeling unwell or having any symptoms (such as fever, cough, muscle ache, joint pain, headaches, sore throat, runny nose, shortness of breath, change in smell, change in taste, diarrhoea)?

Yes

No