Employee Interstate Contact Disclosure Form

Employee Interstate Contact Disclosure Form

To support Community Care TASMANIA respond to the reopening of Tasmania’s borders now the COVID-19 pandemic cases are reducing, all employees who have known contact with persons from other States (either from personal travel or having interstate visitors) are asked to inform Community Care TASMANIA as soon as possible. We will then assess the risk via a telephone call with you to help determine how we can best manage any risk to our clients and participants.

Employee Full Name *

Home Phone No:

Mobile Phone No:

First Date of contact with interstate person/s: * +

Last Date of contact with interstate person/s: * +

Details: *

Interstate Guests

I traveled Interstate

Other: Other:

Full Details: *

Which Australian Town/City *

State *

Employee signature *

clear

Date: * +