CSIRO COVID-19 Screening

Personal Details

The purpose of this Personal Health Declaration is to determine whether you currently have COVID-19 symptoms or are at risk of contracting COVID-19.
Name
MM slash DD slash YYYY

Part A - Important Questions

Are you experiencing a fever > 37.5 degrees or chills/night sweats?
Are you experiencing a cough?
Are you experiencing shortness of breath or lethargy?
Are you experiencing a sore throat or loss of sense of smell/taste?
Have you experienced any of these symptoms in the last 14 days?
If yes, did you have a positive COVID-19 test, PCR or RAT?
Have you been in contact with a suspected or known case within the last 14 days?
Have you recently shared a closed space with a suspected or confirmed case within the last 14 days?
Have you returned from international travel (including a cruise) within the last 14 days?
Have you been contacted by a Contact Tracing Team within the past 14 days and have you been told to quarantine, isolate or get tested?

If you answered YES to any of the above, access to an RV investigator may not be permitted. Please contact your Voyage Operations Manager (VOM) immediately as this may impact your pending deployment. Please continue to monitor yourself for fever and respiratory symptoms and notify your VOM with any changes.

Vaccination details

Compliance status
Max. file size: 200 MB.

Definitions

Confirmed case - a person who tests positive to a validated specific SARS-CoV-2 nucleic acid test. Suspected Case - a person who has not been tested, with fever (>37.5 dgerees) or a history of fever and night sweats, chills) OR acute respiratory sumptoms (e.g. cough, shortness of breath, sore throat) and meets epidemiological criteria. Definitions for cases and contact could change as per CDNA guidelines and will be modified accordingly.

Declaration

Aspen Corporate Health (ACH) is committed to your privacy and will handle any information you provide in accordance with the Australian Privacy Principles (APPs) and the Privacy Act 1988 (Cth). ACH, on behalf of CSIRO's Marine National Facility (MNF), is collecting your health information, along with other personal data such as your name, in order to identify if you need medical attention related to COVID-19. The results may be disclosed with the following to allow for appropriate action: any person involved in your health care should you become unwell, including any treating doctors or specialists; any public health authorities to whom ACH is obliged to report in compliance with legislative or regulatory requirements; CSIRO officers and advisors that play a role in managing the collection and storage of the information; the master, as ASPs representative; other personnel required to manage any medical emergencies or disease outbreaks.
Consent