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COVID-19 Client Triage

Sunnyfield Clients

Complete this form if a client has tested positive for COVID-19, has been exposed to a positive COVID-19 case, or displaying COVID-19 symptoms.

NSW Health COVID-19

ACT Health COVID-19

Click the NSW or ACT Health button to find out the latest COVID-19 information.

COVID-19 Client Triage Questionnaire

"*" indicates required fields

Enter your email address

What is the client’s name as written on their Medicare Card or Driver’s License?*

First Middle Last

What city and state does the client reside?*

City State / Province / Region

What is the client’s date of birth?*

What is the client’s vaccination status?*

What is the client’s guardian’s name?*

What is the guardian’s mobile number?*

Service Questions

Please select the Sunnyfield service type*

Shared Living

Short-term Accommodation

Community Services

Employment Services

What is the name of the Sunnyfield service that the client works/lives/attends?*

Sunnyfield service

Who is the Service Coordinator/Manager?*

First Last

What date was the client last at the service?*

Triage Questions

Has the client has tested COVID positive?*

Yes

No

What was the date of the test?*

Upload the PCR or RAT test results*

If the client has tested positive for COVID. You must upload evidence of the RAT or PCR in order to submit this form to the PRG.

Max. file size: 4 MB.

Has the client has been notified as an exposure to a positive COVID case?*

Yes

No

How was the client notified of their exposure?

SMS

Phone call from PHU

Email from business

Friend or family member

Is the client is displaying COVID symptoms?*

Yes

No

When did the client start displaying symptoms?

What symptoms has the client displayed?

Runny nose

Cough

Fatigue

Fever (temperature over 37.5C)

Sore throat

Loss of taste or smell

Shortness of breath

Headache

Has the client had a test?*

Yes

No

Unknown

If yes, what type of test?*

RAT

PCR

What was the date of the test?*

Where was the test administered?*

What was the result of the test?*

Positive

Negative

Awaiting results

Upload the RAT or PCR results*

Max. file size: 4 MB.

Δ

Sunnyfield statement regarding the Disability Royal Commission

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PO Box 193 Frenchs Forest NSW 1640

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© 2024 Sunnyfield

<img loading="lazy" decoding="async" width="135" height="195" src="https://b2504970.smushcdn.com/2504970/wp-content/uploads/sunnyfield-disability-services-logo.png?lossy=0&strip=1&webp=1" alt="" title="" class="wp-image-468" />

ABN 72 000 415 127
ISO 9001: 2015 Quality Management System
Charity Fundraising Number 13915
Privacy Policy
Sitemap
Terms & Conditions
© 2024 Sunnyfield

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