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Cuboree X 2021 - Health Questionnaire
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This questionnaire must be completed for all attendees (youth and adults) before getting on the bus to Cuboree if travelling by event bus, or before arriving on site.
Please submit your completed questionnaire by Saturday 10th April at 5pm.
Attendee First Name
*
Your answer
Attendee Last Name
*
Your answer
Attendee Scout Membership Number
*
Your answer
Expected Date of Arrival at Cuboree
*
MM
/
DD
/
YYYY
Is the Attendee currently required to be in isolation because they have been diagnosed with coronavirus (COVID-19)?
*
Yes
No
Has the Attendee been directed to a period of 14-day quarantine by the Department of Health and Human Services as a result of being a close contact of someone with coronavirus (COVID-19)?
*
Yes
No
Has the Attendee been in a "Hot Spot" or nominated interstate "Red Zone" (as defined by the Victorian Government) in the last 14 days?
*
Yes
No
If you answered YES to any of the above questions you should not attend Cuboree until advised by the Department of Health and Human Services that you are released from isolation or until your 14-day quarantine period is complete.
If you answered NO to the above questions, proceed to the symptom checklist below.
Is the Attendee experiencing these symptoms?
*
Yes
No
Fever (If you have a thermometer, take the attendee’s temperature.You are considered to have a fever if above 37.5°C)
Chills
Cough
Sore throat
Shortness of breath
Runny nose
Loss of sense of smell
Yes
No
Fever (If you have a thermometer, take the attendee’s temperature.You are considered to have a fever if above 37.5°C)
Chills
Cough
Sore throat
Shortness of breath
Runny nose
Loss of sense of smell
If you answered YES to any of the above questions the Attendee should not get on the bus or enter the Cuboree site. Contact the Cuboree team (
cuboree@scoutsvictoria.com.au
) and get tested for coronavirus (COVID-19).
If you answered NO to all the above questions, the Attendee can get on the bus or enter the Cuboree site.
If you develop symptoms before getting on the bus or arriving at Cuboree, stay at home and seek further advice from the 24-hour coronavirus hotline 1800 675 398 or your general practitioner, and contact Cuboree (
cuboree@scoutsvictoria.com.au
).
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