COVID-19 reporting form for UniSC staff, contractors and volunteers

Telephone or mobile number: *

Date the positive COVID-19 test was taken *

Your COVID-19 test *

I have tested positive to COVID-19

Date when you were last on a USC Campus / Site *

USC campus: *

Sunshine Coast

Moreton Bay

Caboolture

Fraser Coast

Gympie

SouthBank

Other location (as per below)

Other USC locations:

Sunshine Coast Health Institute

Thompson Institute

K'gari Research and Learning Centre (Dilli Village)

Clinical Trials – Sunshine Coast

Clinical Trials – Moreton Bay

Noosa (The J)

Other USC location (please specify):

Select one: *

Staff

Volunteer

Contractor

I declare that the above information is true and correct *

Yes

I consent to USC’s collection of my personal information, including my health information (as provided in this form), for the purposes of USC providing consistent guidance and support to staff and students and otherwise managing its response to the COVID-19 pandemic in accordance with applicable laws including the COVID-19 Emergency Response Act 2020 (Qld) and Chief Health Officer issued Public Health Directions including the Restrictions on Businesses, Activities and Undertakings Direction (No. 5).
My personal information will be managed in accordance with USC’s Information Management – Governing Policy,
USC will not disclose my personal information to any third parties without my consent, unless required by law.

I accept the above declaration

COVID-19 reporting form for UniSC staff, contractors and volunteers | UniSC | University of the Sunshine Coast, Queensland, Australia