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* 1. What is your full name?

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* 2. Are you awaiting a COVID-19 test result?

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* 3. Have you been diagnosed with COVID-19, but have not yet been cleared by the Department of Health?

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* 4. Do you have new/recent-onset symptoms consistent with COVID-19?
(loss of change in sense of smell or taste/fever/chills or sweats/cough/sore throat/shortness of breath/runny nose/headache/muscle soreness/stuffy nose/nausea/vomiting/diarrhoea)

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* 5. Have you had contact in the past 14 days with someone with COVID-19? (except at health care work settings whilst wearing appropriate personal protective equipment)

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* 6. Are you currently required to self-isolate or self-quarantine under the Diagnosed Persons and Closed Contacts Directions of DHHS Victoria because you may have been exposed to COVID-19?

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* 7. Have you entered Victoria from a cross-border area without a cross-border permit, exception or exemption?

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* 8. Do you currently hold a RED or ORANGE zone permit under the Victoria Travel Permit System?

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* 9. Have you visited a Tier 1 exposure site in the past 14 days? Please click the link for list of Exposure sites Victoria

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* 10. Have you visited a Tier 2 exposure site in the past 14 days? Please click the link for the list of Exposure sites Victoria

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* 11. Have you been to a hotel quarantine or port-of-entry facility in the past 14 days? (if you have, please inform staff of your days 17 and 21 COVID-19 test results to keep the facility COVIDsafe)

 
 33% of survey complete.

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