SVHS COVID-19 Screening Entry Protocol form

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Contact Details

Full Name

Contact Number

Email Address (You have our promise that St Vincent’s Health Australia will not share your email address with third parties or use it for any purpose other than this form.)

If you still do not wish to disclose your 'email address', please click here to enter your 'residential address' instead.

Residential Address

Screening Questions

Have you been diagnosed with COVID-19 in the last 10 days?

Yes

No

N/A

Have you been overseas in the last 7 days?

Yes

No

0-7 days

8-14 days

N/A

Have you been identified as a high risk contact of a COVID-19 case or had a high-risk exposure to a COVID-19 case in the past seven 7 days?

Yes

No

N/A

Are you experiencing any COVID-19 symptoms?:

fever (37.5 degrees Celsius or higher)
cough
sore throat
shortness of breath (difficulty breathing)
runny nose
loss of taste
loss of smell

Other reported symptoms include:

fatigue
acute blocked nosed (congestion)
muscle pain
joint pain
headache
diarrhoea
nausea/vomiting
loss of appetite

Yes

No

N/A

Please note anyone with ACUTE/NEW ONSET symptoms should present at a testing site for a COVID test and self-isolate thereafter until results. Anyone with CHRONIC symptoms should not be answering yes to the questions.

Have you had a high risk (household or household like contact) exposure to someone who has COVID-19 in the last 14 days?

Yes

No

N/A

Do you have a confirmed negative test for this diagnosis or a clearance from the DHHS?

Yes

No

N/A

Are you currently required to self-isolate?

Yes

No

N/A

Have you completed your period of self-isolation?

Yes

No

N/A

Have you been overseas or interstate within the past 14 days?

Yes

No

N/A

Have you been to any known hot spots as identified by NSW Health?
(Click here to view the Latest COVID-19 news and updates)

Yes

No

N/A

What is you vaccination status?

Zero

One

Two or more

N/A

Have you come in contact with a person who has a confirmed case of COVID-19 within the past 14 days without using prevention precautions and personal protective equipment (PPE)

Yes

No

N/A

Have you tested positive to another acute respiratory infection in the last seven days?

Influenza A/B

Parainfluenza

Rhinovirus

RSV

No, I haven't

N/A

N/A N/A

Thank you for completing this form.

If you could proceeed to see the staff at the temperature checking station, presenting this screen to them, they will assist you for your visit.

You can also download Bindi Maps if you need help finding your way around the hospital.

Due to one or more of your answers to the screening questions, you have been identified to be at risk.
Staff may require further information at the screening station.

Please call your manager to discuss your specific circumstances and what to do next.

Please contact your contract manager if you have any concerns or require further information.

SVHS COVID-19 Screening Entry Protocol form

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Hi , thank you for completing the screening questions earlier today.

Contact Details

Screening Questions

You are free to enter our facility pending temperature check.

You can also download Bindi Maps if you need help finding your way around the hospital.

Thank you for completing this form.

You have recently returned from overseas. If you are not here for emergency care you require a risk management plan or exemption. If you were not aware of this please contact the team providing your care (or manager for staff) before entering.

You must show evidence of negative day 7 swab.

To enter you will require a visitor exemption. Please see the level 3 reception desk..

If you could proceeed to see the staff at the temperature checking station, presenting this screen to them, they will assist you for your visit.

You can also download Bindi Maps if you need help finding your way around the hospital.

Due to one or more of your answers to the screening questions, you have been identified to be at risk.
Staff may require further information at the screening station.

Outpatient appointments are not permitted.

Due to the answers you have provided and current NSW health guidlines you are not currently able to enter this healthcare facility.

Links:

Thank you for checking out of this location

Hi , thank you for completing the screening questions earlier today.

Contact Details

Screening Questions

You are free to enter our facility pending temperature check.

You can also download Bindi Maps if you need help finding your way around the hospital.

Thank you for completing this form.

You have recently returned from overseas. If you are not here for emergency care you require a risk management plan or exemption. If you were not aware of this please contact the team providing your care (or manager for staff) before entering.

You must show evidence of negative day 7 swab.

To enter you will require a visitor exemption. Please see the level 3 reception desk..

If you could proceeed to see the staff at the temperature checking station, presenting this screen to them, they will assist you for your visit.

You can also download Bindi Maps if you need help finding your way around the hospital.

Due to one or more of your answers to the screening questions, you have been identified to be at risk. Staff may require further information at the screening station.

Outpatient appointments are not permitted.

Due to the answers you have provided and current NSW health guidlines you are not currently able to enter this healthcare facility.

Links:

Thank you for checking out of this location

Due to one or more of your answers to the screening questions, you have been identified to be at risk.
Staff may require further information at the screening station.