QR CODE Entry Points – National Critical Care Trauma Centre

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PLEASE ENTER YOUR DETAILS BELOW

Do you have a AUSMAT STAFF ID#?*

YES
NO

STAFF AUSMAT ID #*

STAFF ID #*

NAME

NAME*

Name*

First Last

Company Name*

ON ENTRY: What was your temperature?*

My temperature recorded in the last 30 minutes was*

< 35.5
35.5 - 37.4
≥ 37.5 ≥ 37.5 Please self-isolate contact TEAM DOCTOR 0427 329 433

I have developed one (or more) of the following symptoms in the last 24 hours since the last check-in. (Fever, cough, sweats/chills, headache, shortness of breath, sore throat, runny nose, diarrhoea, vomiting, loss of smell or taste)*
YES - Please self-isolate
If answer is YES please call TEAM DOCTOR 0427 329 433
NO

I am worried about potential exposure risk or near miss in the last 24hr*
YES
If answer is YES please call TEAM DOCTOR 0427 329 433
NO

Any additional comments you would like to add

Information ENTRY

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