Valley Fresh Cherries & Stonefruits
Valley Fresh Cherries & Stonefruits
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Covid Safe
Employee Health Declaration
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Indicates required field
Employee Name
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First
Last
[object Object]
Phone Number
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Employee Address
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Email
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Employment Start Date
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HEALTH DETAILS : Has the Employee:
Travelled internationally within the last 14 days?
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Yes
No
Been exposed to a person who has travelled internationally within the last 14 days?
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Yes
No
Do you have any symptoms of COVID-19 such as : Fever, Flu like symptoms Coughing, Sore Throat, Fatigue or Shortness of Breath?
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Yes
No
Been exposed to a person with COVID-19 with the last 14 days?
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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?
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Yes
No
Have you received the COVID-19 Vaccine?
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One Injection
Two Injections
None
I,
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(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