Return to work for positive - COVID-19 cases

Symptom Assessment Form
The Symptom Assessment Form is part of the return to work program for positive COVID-19 cases. This form is to be completed by the Manager with the staff member. 

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

Symptom Assessment Form

"*" indicates required fields

Please select Sunnyfield Service*
Manager's Name
Staff Member's Name*

Questions for the staff member who tested positive for COVID

MM slash DD slash YYYY
Do you have a sore throat?*
Do you have a runny nose?*
Do you have a cough?*
Are you suffering from shortness of breath?*
Date of return to work*

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