Covid Check List

Valley Fresh Cherries & Stonefruits

Valley Fresh Cherries & Stonefruits

Home
Our Story
Farm Gate Sales
Work with Us
Get in Touch

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

Have you received the COVID-19 Vaccine? *

One Injection Two Injections None

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