Tangalooma Villa 19

COVID-19 Declaration

COVID-19 Self Declaration Form: Tangalooma Villa 19

The purpose of this health declaration form is to determine whether you are at risk of contracting or currently have signs / symptoms of COVID-19. The Resort is following Government regulation and requires Vaccination Status of each guest staying or visiting publicly of privately. Please do not be offended by this, it is a nightmare for us as well.

Please complete this electronic form within 72 hours of arriving at Villa 19 Tangalooma.

Main Guest Full Name
Vaccination Status Primary Guest
Arriving Guest Departure Point (s)
Registration required if travelling by MICAT
Street Address (No PO Boxes please)
Mobile:
Email:

Please list each guest name (please include their first & last names & ages if under 14 years old)

Guest 2
Vaccination Status Guest 2
Guest 3
Vaccination Status Guest 3
Guest 4
Vaccination Status Guest 4
Guest 5
Vaccination Status Guest 5
Guest 6
Vaccination Status Guest 6
Guest 7
Vaccination Status Guest 7
Guest 8
Vaccination Status Guest 8
In the last 14 days have you been:
In the last 7 days have you or a 'close contact' of yours tested positive to COVID-19?
(If you answered 'Yes' to Question 1) Do you confirm that you have followed and completed all Qld Government requirements for Isolation and Quaratine prior to today's travel?
In the last 7 days (including today) have you had any of the following symptoms, however mild, of COVID-19 or Influenza (the 'flu'); such as: * a cough * fever above 37.5 * sore throat * lack of taste/smell * body aches/pains, or fatigue * hot or cold flushes * vomiting or nausea * Shivering * shortness of breath * generally feeling unwell.
(If you have answered 'YES' to Question 3) Do you confirm that you no longer have any COVID-19 symptons & have received a PCR or Rapid Antigen Test ('RAT') confirming you are negative to COVID-19?
FOR THE FULL DURATION OF YOUR VISIT - Do you meet all QLD Government mandated vaccination requirements to access Tangalooma Boat Launches, enter Resort cafe's, restaurants, conference facilities & bars: or participate in Tourism Experiences operated by the Resort. Your accommodation ,VILLA 19.
Note;
All guests 16 years and over must be fully vaccinated and be able to provide Tangalooma Island Resort staff official evidence of vaccination to access / attend any of these venues, vessels, or experiences from 17th December 2021 onwards.
Are there other Resort Guests known to you visiting or staying in Resort or on Moreton Island? Eg: Villas, Houses, Resort, Camping. (Please advise and property number(s) if known)
Villa registration Forms, Licence, I.D. etc
Do you have the COVID-SAFE app on your smartphone? (It is advised that you have this app installed & activated on all smartphones in your guest group)
As a part of our plan we have to verify guests in our Villa. Please take a clear photo of the front and reverse of your driver\'s licence with your smartphone and either email to villa19@tangaloomavilla.com or SMS to 0413 896 885 prior to your arrival at Villa 19 Tangalooma. We ask that this is done at the same time as declaration so that we can keep and file details together. Your photo I.D. information will not go past us and only verified details will be passed on if required. This will be deleted in appropriate time frame.
I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake to inform you of any changes therein, immediately. I understand further that I will advise Tangalooma Villa 19 owners & management if any of my guests show symptoms or are diagnosed with Covid 19 following their departure.

This form and its information will not be used for marketing purposes and will be destroyed as required in line with government advice.

Please check that you have completed each *mandatory field* to enable you to submit competed form.

For security verification, please enter any random two digit number. For example: 54