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

Questions for the staff member who tested positive for COVID-19

Did you receive an SMS from NSW or ACT Health for the end of your 7-day self-isolation?*
Did you send a copy of the medical release from NSW or ACT Health to*
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*

Essential Worker Risk Management Plan

The Risk Management Plan applies to all essential workers and must be in place for 7 days from the date of return to work.
Have you discussed the Risk Management Plan with the staff member?*

Skip to content