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COVID-19 Risk Assessment

This form is a risk assessment questionnaire for screening purposes to ensure the participant has not tested positive to COVID-19 or been directed to isolate by SA Health. In the case that the participant has COVID-19 or been directed to isolate this will be flagged and the face-to-face meeting will be cancelled in accordance with SA Health directives.

Details

DD slash MM slash YYYY
Time of Meeting(Required)
:
Address of Meeting(Required)

Screening Questionnaire

Is anyone in your household currently experiencing any COVID-19 symptoms (such as Fever, Sore throat, Cough, or loss of taste or smell) and /or waiting for test results?(Required)
Do you or a household member have COVID or have been directed to self isolate by SA Health in the last 14 days?(Required)
In the last 10 days, have you or a household member been identified as a 'close contact' of someone who currently has COVID-19?(Required)

Guidelines for Visiting

I Can Jump Puddles team members may still visit clients; however, must take extra precautions. These include: • making sure visits are kept short • allowing no more than two visitors, at a time • following best practice hygiene – including washing and sanitising hands before and after visit • making sure visits occur in a spacious room or consider outdoors, where appropriate, to satisfy social distancing guidelines – 4 square metres indoor space per person • ensuring there are no large group visits or gatherings, including social activities or entertainment