COVID-19 Pre-screening Questionnaire

All participants must complete this questionnaire no more than 24 hours prior to attending a Primal Adventure.
If you are the parent or carer of a child under 18 who is attending, please complete one form for each child attending.

Thank you

COVID-19 Pre-screening Form

This form is for all participants to complete 24 hours prior to attending a Primal Adventures trip. If you are a parent/carer of a participant under 16 years, please complete one for each child attending.

Your Name*
First Last
Child's Name
Parent/guardian, please complete for each child under 16. If completing on behalf of a child, all questions below relating to 'you' relate to the child
First Last
1. Have you ever been diagnosed with COVID-19*
- No
- Yes
If you checked 'yes' in Question 1, please provide date of diagnosis, and date of last negative test.*
2. Do you have any COVID-19 symptoms?*
- I have one or more of the following: fever above 37.5, cough, shortness of breath, runny nose, sore throat
- I don't have any symptoms
3. Have been in contact with or done any of the following in the past 14 days; someone diagnosed with COVID-19, travelled internationally, travelled to an area within Australia considered high risk for community transmission*
- No
- Yes