COVID-19 Volunteer Form COVID-19 Volunteer Travel & Wellness Declaration This form is to be completed before coming to volunteer at the Purple House. Name* First Last Q1. I have been overseas or interstate in the last 14 days* Yes No Please list the countries or states/territories you visited and the dates you were there:Q2. Do you have COVID-19 symptoms?* Yes = get tested! No If you answered 'yes', you need to get tested, isolate and discuss your arrival/return to Purple House with the Volunteer Coordinator or HR team.Declaration* Given the extreme vulnerability of Purple House patients and their communities I will do everything I can to keep them and the staff safe. I also acknowledge that if I cannot meet the COVID-19 requirements of Purple House I may not be permitted to enter Purple House facilities. (Note: Purple House is not liable for any financial impacts this might have.) I have read and understood the latest Purple House COVID-19 Response Plan (available from https://www.purplehouse.org.au/services/covid-19) I am committed to implementing good hand hygiene, physical distancing, and cleaning processes while performing my volunteer role with Purple House. If I develop any COVID-19 symptoms prior to or during my time volunteering at any Purple House premises I will immediately inform the Volunteer Coordinator and stay away from Purple House. Signature* Typing your name here and submitting this form is considered formal confirmation of all the information you have provided in this form.Date* DD slash MM slash YYYY Δ
