PHDR COVID Form

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PHDR COVID Form

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Name *

Email *

Phone number *

Arrival time *

Time

Number of Dependents *

COVID - 19 Declaration *

Yes

Do you have any symptoms associated with COVID-19 virus, such as a raised temperature, cough, sneezing, runny nose, body aches, and/or difficulty in breathing?

Have you had close contact with or cared for any person who has exhibited any of the above symptoms?

Have you had contact with any person who has been diagnosed with COVID-19 in the past 14 days?

Have you, or any members of your household, or anyone that you have been in contact with, travelled outside Australia in the past 14 days (of today’s date)?

If you develop any of the symptoms associated with COVID-19 virus within 7 days of visiting the Pine Hills Dirt Racing facility, would you please advise a PHDR committee member so that we can take any necessary quarantine measures?

Have you, or any member of your household or anyone you have been in contact with, been to a declared COVID-19 hotspot in the past 14 days (of todays date)

Yes

Do you have any symptoms associated with COVID-19 virus, such as a raised temperature, cough, sneezing, runny nose, body aches, and/or difficulty in breathing?

Have you had close contact with or cared for any person who has exhibited any of the above symptoms?

Have you had contact with any person who has been diagnosed with COVID-19 in the past 14 days?

Have you, or any members of your household, or anyone that you have been in contact with, travelled outside Australia in the past 14 days (of today’s date)?

Have you, or any member of your household or anyone you have been in contact with, been to a declared COVID-19 hotspot in the past 14 days (of todays date)

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