Visitors to ACT Sunnyfield Shared Living Services

ACT Health has introduced new requirements for visitors to residential disability care facilities; visitors to Sunnyfield Shared Living homes must complete these screening questions prior to attending a Shared Living Service.

For more information about these recent changes please click here.

Visitor's name(Required)

First Last

Visitor's mobile number(Required)

Name and address of the service you are visiting?

Service name Address City State / Province / Region ZIP / Postal Code

Who are you visiting?(Required)

Relationship to Client?(Required)

What date would you like to visit the house?(Required)

DD slash MM slash YYYY

Do you have any COVID-19 symptoms?(Required)

Yes

If yes, please select

Runny nose

Cough

Tiredness

Fever (temperature above 37.5▫C)

Sore throat

Loss of taste or smell

Do you live with a person who has tested positive for COVID-19 within the last 14 days?(Required)

Yes

Are you a high-risk contact of a person who tested positive for COVID-19 within the last 14 days?(Required)

Yes

Are you in isolation because you have COVID-19 or you are waiting for results of a COVID-19 test?(Required)

Yes

Do you live with a person who has COVID-19 symptoms and is currently waiting for results of a COVID-19 test?(Required)

Yes

Have you recovered from COVID-19 in the last week but have ongoing symptoms?(Required)

Yes

How did you hear about us?(Required)

Other(Required)

Any other comments?

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1300 588 688
enquiries@sunnyfield.org.au
PO Box 193 Frenchs Forest NSW 1640

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