COVID-19 Self Declaration Form The purpose of this health declaration form is to determine whether you are at risk of contracting or currently have signs / symptoms of COVID-19. Main Guest Full Name* First Last Arrival Date* MM slash DD slash YYYY Departure Date* MM slash DD slash YYYY Address* Street Address City State Postcode Contact Number*Email* Holiday Property Address* How many guests will be staying at the property?* Please list each guest name (please include their first and last names)*Are any guests experiencing any of the following symptoms: Loss of Smell, loss of taste, cough sore throat, fatigue, aches and pains, shortness of breath, runny or stuffy nose, headaches or raised temperature* Yes No Please list the guest name/s and details of those experiencing these symptomsHiddenHas any guest returned from travel outside of Queensland in the past 14 days?* Yes No HiddenPlease list the guest name/s and provide more details of the situationHas any guest been in close contact with a person who has returned to Australia in the last 14 days or potential contact with someone that is suspected to have COVID-19?* Yes No Please list the guest name/s and provide more details of the situationHas any guest been exposed to anyone that is suspected or confirmed to have COVID-19?* Yes No Please list the guest name/s and provide more details of the situationDeclaration*I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake to inform you of any changes therein, immediately. I understand further that I will advise Aspire Property Management if any of my guests show symptoms or are diagnosed with Covid 19 following my departure. Yes No Full Name* Dated* MM slash DD slash YYYY Δ
