CORONAVIRUS (COVID-19) HEALTH QUESTIONNAIRE
For Dance World Studios / APO Arts Academy
Venue address:295 Bank Street South Melbourne VIC 3205

The safety of all students, employees and guests entering the premises is our overriding priority. As the coronavirus (COVID-19) pandemic continues, we are monitoring the situation closely and in order to prevent the spread of the coronavirus and reduce the potential risk of exposure to our workforce, we are asking everyone to complete and submit this questionnaire prior to entering the worksite.

Please respond to each of the following questions truthfully and to the best of your ability.
To be completed on date of entry (not earlier)

Your participation is important to help us take precautionary measures to protect you and other personnel in the workplace.

Name*
(select one)
Are you currently required to be in isolation because you have been diagnosed with COVID-19?*
Have you been directed to quarantine as a result of being a close contact of someone with COVID-19?*

If you answered YES to either of the above questions, you should not enter the studio. All personnel with symptoms, even mild cases, will be required to do a Rapid Antigen Test (RAT) and return a negative result to proceed beyond the reception area. DW does not supply RATs.

If you answered NO to the above questions, proceed to the symptom checklist below.

Fever (If you have a thermometer, take your own 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 or taste*

If you answered YES to any of the above questions you should not enter the studio. Go home, and get tested for coronavirus (COVID-19).

If you answered NO to all the above questions, you can enter the studio.

If you develop symptoms, stay at home and seek further advice from the 24-hour coronavirus hotline 1800 675 398 or your general practitioner.

DECLARATION*