COVID-19 Screening & Declaration Form

Students and visitors are required to complete this declaration truthfully. Students providing a false declaration will be dealt with under the Student Misconduct Rule 2020.

Completion of this information is to help keep our staff, students and other workers safe while conducting activities on campus. This screening is to help reduce the risk to yourself, students, staff and the wider community.

We encourage you to add this form to your home screen or favourites as you will need to fill-out prior to your arrival and every Monday thereafter.

My contact details
My visit details

COVID-19 Screening
Have you been to a location classified by NSW Health as a case location or area of concern, venue of concern or interstate case location in the past 14 days? * Case location or area of concern, Venue of concern, Interstate case locations
Have you been in the Greater Sydney Area (including the Blue Mountains, Central Coast, Wollongong and Shellharbour) in the past 14 days? *
To the best of your knowledge, have you been in close contact with someone who has tested positive for COVID-19 in the past 14 days? *
To the best of your knowledge, have you been in contact with anyone who has been to a location which is known to have active case alerts for COVID-19 in the last 14 days? * For information around currently impacted locations, please visit the NSW Health website, or Health Direct for other states.
Are you waiting for a test result or had a positive test result in the last 14 days? *
Have you been told or been given instruction to self-isolate for 14 days (and is this 14 day period still current)? *

If you answered YES to any of the above, DO NOT ATTEND OUR CAMPUS TODAY

Privacy statement

Charles Sturt University, Panorama Avenue, Bathurst is collecting this information for the purposes of assisting Charles Sturt University and NSW Health with contact tracing, and it will be managed in accordance with the NSW Privacy and Personal Information Protection Act 1998 and the University’s Privacy Management Plan. We will hold this information securely for 28 days and provide it to NSW Health if requested. A copy of NSW Health’s Privacy Management Plan can be found here. The information held by Charles Sturt will be securely deleted when it is no longer needed.

Submitted data resides on Charles Sturt Datacentre Infrastructure on Australian servers for data sovereignty. Requests for the data can be made by email to webimprovement@csu.edu.au

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