COVID-19 Advice COVID-19 Notification Form

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COVID-19 Notification Form

The below form is to be completed by staff, students and other JCU associates who are required to quarantine or isolate as a result of a positive COVID-19 case.

Once completed, this form is CONFIDENTIAL. The information gathered is for the purposes of:

  • Ensuring welfare support to staff/students impacted by COVID-19
  • To notify staff/students who may have attended those work areas or study locations to closely monitor their symptoms as there may be an increased risk of infection
  • To initiate additional cleaning if required

Note: Routine cleans will be conducted as required, in line with Public Health guidelines

For information on isolation requirements for those diagnosed with COVID-19, visit the QLD Government website for the latest advice from QLD Health

Information for release from quarantine/isolation can also be found through the above link.

Required fields are marked with an asterisk (*).

Details of person in quarantine

Status

Date of quarantine commencement *

JCU Attendance

Student Attendance

After completing this form, please contact your placement/WIL provider. Please also contact your placement team. Placement team email addresses can be found here.

Date of learning activity 1

Start time of learning activity 1

e.g. NS2771

Date of learning activity 2

Start time of learning activity 2

e.g. NS2771

Date of learning activity 3

Start time of learning activity 3

e.g. NS2771

Date of learning activity 4

Start time of learning activity 4

e.g. NS2771

Date of learning activity 5

Start time of learning activity 5

e.g. NS2771

Date of learning activity 6

Start time of learning activity 6

e.g. NS2771

Date of learning activity 7

Start time of learning activity 7

e.g. NS2771

Date of learning activity 8

Start time of learning activity 8

e.g. NS2771

Limit reached!

Staff Attendance

e.g. 10/02/22, 9:15, Building 029, Room 106, meeting 45min
11/02/22, 11:00, Building 029, Room 104, meeting 1hr

Date of teaching activity 1

Start time of teaching activity 1

Date of teaching activity 2

Start time of teaching activity 2

Date of teaching activity 3

Start time of teaching activity 3

Date of teaching activity 4

Start time of teaching activity 4

Date of teaching activity 5

Start time of teaching activity 5

Limit reached!

Other Attendance

e.g. 10/02/22, 9:15, Building 029, Room 106, meeting 45min
11/02/22, 11:00, Building 029, Room 104, meeting 1hr

You should also tell anyone who you spent time with from the 2 days before you started having symptoms or tested positive — whichever came first — that you have COVID-19. This can include people at your workplace, school or social contacts.