VisitorQR

Consent for storing submitted data *

Yes, I give permission to store and process my data

Visitor First Name *

Visitor Last Name *

Additional People

Contact Number *

What Is Your Home Town/Suburb

Are You Under 18 *

No
Yes

Site *

Visiting Area *

Reason for Visit *

First Name of Patient You Are Visiting

Last Name of Patient You Are Visiting

Keep the above details (name etc) stored on this device

Planned Date of Visiting *

Time Hour *

Time Minute *

Time AM/PM *

AM
PM

Your Visit Code

Have you had COVID-19? *

No
Yes

Have you been given clearance from isolation?

No
Yes

Are you awaiting COVID-19 test results

No
Yes

Have you been identified as a primary or secondary contact of a person confirmed as having COVID-19 within the past 14 days?

No
Yes

Have you been to an identified hotspot in Victoria or interstate within the past 14 days as listed TODAY on the DHHS website?

No
Yes

Have you arrived in Australia within the past 14 days?

No
Yes

Was it from a quarantine free zone?

No
Yes

Have you been in hotel quarantine in the past 7 days?

No
Yes

Have you received a negative result from your 7-day post leaving hotel quarantine test?

No
Yes

Do you have any symptoms of a respiratory infection (e.g. cough, sore throat, shortness of breath or runny nose)? Any fever or chills?

No
Yes

Security *

Visitor Via QR