Contact Tracing | GAJA By Sashi

MONDAY-THURSDAY: DINNER 5:30pm - 9:30pm

First Name

Last Name

Phone Number

I have not recently returned from overseas or interstate

I am not experiencing the symptoms: fever, cough, sore throat

I have not been in close contact with a Covid-19 patient in the last 14 days

Initials

Date

Time

I declare that the info I’ve provided is accurate & complete

Screening Successful!