Anglicare Site Visitor Check-In

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ANGLICARE WORKSITE VISITOR CHECK-IN FORM
30 Scotts Crossing, Canberra ACT

Date*

DD
MM
YYYY
Check-In Time*

: HH

MM
Name*
First Last
Phone*
Organisation (if applicable)
Service or Program Visiting*
Key and Swipe Cards*
- 'Contractor 1'
- 'Contractor 2'
- 'Staff Spare'
- No key or swipe card issued
COVID-19 Health Check*
I understand that I must formally agree and acknowledge each of the statements below or I will not be permitted to enter this Anglicare location.
• I am feeling well
• I am not experiencing any cold or flu like symptoms
• I have not been in contact with anyone that is confirmed to have (or currently being tested for) COVID-19
• I have not visited a COVID-19 hotspot or exposure site in the past 14 days
- Yes, I formally acknowledge the statements above.
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Anglicare acknowledges Aboriginal and Torres Strait Islander people as the Traditional Owners and Custodians of our land and seas. We acknowledge the history of this land and for the stories of resilience and survival which make up Indigenous Australia. We give thanks for Aboriginal Elders and Knowledge Keepers of every generation, including the many Aboriginal families and communities which contribute to the life of our region. Read more about our Reconciliation Action Plan.

ANGLICARE WORKSITE VISITOR CHECK-IN FORM 30 Scotts Crossing, Canberra ACT

ANGLICARE WORKSITE VISITOR CHECK-IN FORM
30 Scotts Crossing, Canberra ACT