Covid Check List

Valley Fresh Cherries & Stonefruits
4179 Olympic Highway South, Young NSW

Valley Fresh Cherries & Stonefruits

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Covid Safe
Employee Health Declaration

* Indicates required field

Employee Name *

First

Last

[object Object]

Phone Number *

Employee Address *

Email *

Employment Start Date *

HEALTH DETAILS : Has the Employee:

Travelled internationally within the last 14 days? *

Yes No

Been exposed to a person who has travelled internationally within the last 14 days? *

Yes No

Do you have any symptoms of COVID-19 such as : Fever, Flu like symptoms Coughing, Sore Throat, Fatigue or Shortness of Breath? *

Yes No

Been exposed to a person with COVID-19 with the last 14 days? *

Yes No

Have you travelled to or come from a COVID-19 Hot Spot locations listed on the NSW Health Website in the last 14 days, ? *

Yes No

I, *

(insert name), declare that the information I have provided is True and Correct.

Date *

If, you answered YES to any of the above question, you are required to Isolate for 14 days or have a COVID-19 test before commencing employment with Valonuma PTY LTD

Submit

Valley Fresh Cherries & Stonefruits
4179 Olympic Highway South
YOUNG NSW 2594
+61448842930
ABN 76 939 227 685