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    Day Pass Visitor Form


    Emergency Contact Details


    I attest that:

    * I am not experiencing any symptoms of illness such as cough, shortness of breath or difficulty breathing, fever, chill, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or small.
    * I have not travelled internationally within the last 14 days.
    * I am currently fit and well.
    * I have not had to take any long-term medication prescribed by a doctor in the last 12 months.
    * I am not currently under the care of my own doctor or hospital for investigation into any medical condition or symptoms.
    * I have no undue problems taking exercise such as walking, running for a bus, swimming, lifting day to day objects.
    * I haven’t with the last 3 months had any surgery or a serious injury, including a fracture.

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