Covid Check-in - Built Lifestyles

COVID Saftey Plan

Project Name:

PROJECT ADDRESS:

COVID MARSHALL:

MOBILE:

NOTE: All information requested is in order to comply with the Public Health Order.

Name*

Please provide your name

First Name Last Name

Email*

Please provide your email address

Phone*

Please provide your mobile number

Do you live in an affected LGA*

Yes
No

Can you provide evidence of receiving two vaccinations*

Yes
No

Can you provide evidence of receiving one vaccination at least three weeks (21 days) prior to today*

Yes
No

Can you provide evidence of receiving one vaccination less than three weeks (21 days) prior to today and a negative COVID-19 test within the last 72 hours*

Yes
No

Are you able to provide evidence of an Exemption due to medical or other conditions that make vaccination unsuitable. Not agreeing with vaccinations is not a suitable excuse*

Yes
No

Public Health Order Acknowledgment*

I acknowledge, that in accordance to Public Health Orders I am not authorised to enter this building site

Yes

I have scanned the NSW Government QR code system upon entering and will check out when leaving the site*

Yes

Acknowledgement*

I acknowledge that I have read, understood and agree to comply with the COVID Safety Plan for the Project. I acknowledge that I have answered all questions truthfully and agree to co-operate with NSW Health, SafeWork, the COVID Marshall for the project if required

Yes

Signature*

COVID Saftey Plan

Contact Us

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