Covid-19 Self Declaration Form for Guests

COVID-19 Self Declaration Form for Guests

The purpose of this health declaration form is to determine whether you are at risk of contracting or currently have signs / symptoms of COVID-19.

Arrival Date*
DD slash MM slash YYYY
Departure Date*
DD slash MM slash YYYY
Main Guest Full Name*
Contact Number*
Email*
Address of main guest*
Street Address City State Postcode
Name of second adult guest
Contact number of second adult guest
Email of second adult guest
How many ADULTS will be staying at Coral Beach Resort?*
How many CHILDREN will be staying at Coral Beach Resort?*
Please list each additional guest name not detailed above (first & last names) Enter None if you are a single guest*
Are any guests experiencing any of the following symptoms: Loss of Smell, loss of taste, cough sore throat, fatigue, aches and pains, shortness of breath, runny or stuffy nose, headaches or raised temperature*
- Yes
- No
Please list the guest name/s and details of those experiencing these symptoms
Has any guest been in one of the high risk Covid exposure venues on the designated days and times?*
- Yes
- No
Please list the guest name/s and provide more details of the situation
To your knowledge, has any guest been in close contact with a person who has been in one of the high risk Covid exposure venues?*
- Yes
- No
Please list the guest name/s and provide more details of the situation
Has any guest been exposed to anyone that is suspected or confirmed to have COVID-19?*
- Yes
- No
Please list the guest name/s and provide more details of the situation
Declaration*
I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake to inform you of any changes therein, immediately. I understand further that I will advise Coral Beach Noosa Resort if any of my guests show symptoms or are diagnosed with Covid 19 following your departure.
- Yes
Full Name*
Dated*
DD slash MM slash YYYY
This information is being collected for the purposes of Covid-19 mitigation and contact tracing, and will not be used for any other purpose. The information will be deleted 56 days after your departure. Coral Beach Noosa Resort follows the government health advice on operating in a Covid Safe environment. All travel is undertaken at your own risk.