COVID-19 Visitor Screening Questionnaire

You can complete the COVID-19 Visitor Screening Questionnaire below.

Do you have, or have recently, displayed the following symptoms of COVID-19? Fever (≥37.50C) OR recent history of fever (e.g. night sweats, chills), without a known source OR acute respiratory symptoms (including cough, shortness of breath, sore throat, runny nose) OR acute loss of smell or taste.*This field is required.
Have you been in contact with a confirmed COVID-19 person or visited a confirmed COVID-19 exposure site in the past 7 days?*This field is required.
Have you been asked to self-isolate by the Department of Health?*This field is required.
In the past 14 days, have you been in close contact with anyone suspected of having COVID-19, or are you awaiting test results?*This field is required.
Proof of Vaccination is required for meeting with Shire Officers within the Administration Office, Civic Centre and Operations Centre. Are you able to provide Proof of Vaccination or exemption in the format specified by the WA State Government upon attendance at your meeting?*This field is required.