Skip to navigation
Skip to content
A NSW Government website
Sydney Children's Hospital Network
COVID-19 Staff Testing & Close Contact Form
Home
Positive test or Close contact
SCHN facility
Please select...
CHW
SCH
NETS
Bear Cottage
Children's Court Clinic
Other
Employee no
First name
Surname
Date of birth
Mobile phone number
Best email you can access at home
Specialty
Please select...
Medical
Nursing
Allied Health
Admin/Corporate Services
Scientific/Technical
Other
Manager
Manager's email
Status
Positive rapid antigen test (RAT)
Date of rapid antigen test
Positive PCR test
Date of positive PCR
Close contact of COVID-19
Date exposed (if known)
Time exposed (if known)
I have my manager's permission to return to work as a close contact
Return to work date
Date last at work
Document your shifts and activity at work in the previous 48 hours before your positive result
Enter N/A if not applicable.
List PPE worn and duration of staff interaction within 1.5m or in a closed space for 30 minutes or more e.g meetings, conversations, tea rooms
Enter N/A if not applicable.
Please provide staff details
Enter N/A if not applicable.
List PPE worn and duration of patient/family interaction within 1.5m or in a closed space for 30 minutes or more e.g. patient care, procedures
Enter N/A if not applicable.
Please provide patient/family details
Enter N/A if not applicable.
Submit