COVID-19 Notification Form

Name of case

Staff/Student

Are you a close contact or positive case?

Campus

Email of case

Phone number of case

Lecturer name (if applicable)

Course name (if applicable)

Are you a VETDSS (Secondary) student or do you lecturer VETDSS students?

When did you first develop symptoms (if applicable)

Please advise the date and time when you first tested for COVID-19 (if applicable)..

When were you last on campus?

If you were on campus whilst infectious (48 hours prior to feeling symptoms) can you please advise the names of any CR TAFE staff that you had contact with for more than 15 minutes? (if applicable)*

Additional details of case.

Name of person completing form (if not the case).

On submitting this form you may be contacted by the COVID Incident Coordinator shortly for further information. For further information, please contact the COVID-19 Incident Coordinator on 9956 2705 or via email COVIDCommunications@crtafe.wa.edu.au

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COVID-19 Notification Form

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