Daily Health Check Daily Health Check Full Name:* Phone*Email* Screening ChecklistHave you or anyone in your household been overseas, had close contact with any confirmed COVID-19 cases, or been directed to self- quarantine for any reason within the past 14 days?* Yes No Have you visited any COVID-19 exposure sites as listed on state health websites?*NSW Health DHHS (Vic) Yes No Are you currently under a stay at home order?* Yes No Have you undertaken a COVID test within the past 72 hours?* Yes No What was the result?* Negative for COVID-19 Positive for COVID-19 Still awaiting results Have you experienced any of the following symptoms within the past 14 days?Fever* Yes No Sore Throat* Yes No Cough* Yes No Shortness of Breath* Yes No DeclarationsDeclaration* I declare that:The responses provided on the screening checklist are true to the best of my knowledge;I will comply at all times with all COVID-19-related policies and procedures of the Production and any related direction or instructions provided by the safety supervisor, COVID officer, or production crew during the shoot;I will wash/sanitise my hands on arrival and as needed during the dayI will wear Personal Protective Equipment (PPE) if requested to do so;I will maintain social distancing practices at all times;I will inform the production crew immediately if I begin to develop symptoms during the shoot;I will notify Screenwise by calling 02 9281 4484 immediately if I present with symptoms in the next 14 days and if I subsequently test positive for COVID-19Consent* I consent to the following:In the event that I or another attendee of the shoot returns a positive test for COVID-19 in the 14 days following the shoot, I consent to my name and phone number being disclosed to relevant health authorities for contact tracing purposes.By submitting this form I acknowledge and accept that I have been duly briefed in preparation for this shoot, and that I understand my duty to take reasonable care of my own health and safety and to not compromise the health and safety of others.Today's Date* DD slash MM slash YYYY One or more of your answers does not meet the requirements. Please contact your point of contact on set immediately and do not enter the set.