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COVID-19 Reporting Form

Published: 01 Apr 2020

COVID19-self-isolation-form

The health, safety and wellbeing of the CIT community is important to us and the information collected on this form is necessary for the CIT to manage an appropriate response to the risk of COVID-19.

The information will only be used by authorised CIT staff for this purpose. A member of CIT staff may be in contact with you regarding the necessary arrangements for work or study. The information will not be disclosed outside CIT unless otherwise required by law. Information will be de-identified for consideration by CIT's Business Continuity Team. Please see CIT's Privacy Policy on our website for more information about how CIT will handle your personal information.

Fields marked with * are required.

Date of lodgement*

Your Details:

Given name*
Surname*
Contact number*
Email address*
I am making this report for*
If you're reporting for someone else, what is your relationship to the affected person?

Details of affected person:


Please enter your details again if you are reporting for yourself.

Affected person's given name*
Affected person's surname*
Affected person’s contact number*
Affected person’s email address*
The affected person is*
CIT staff or student number? (if known)
CIT Campus*
Does the affected person live in student accommodation?*
CIT College/Division*
Department/Course of study*
Has the affected person recently returned from overseas?*
What date did the affected person return from overseas?
Which country did the affected person return from?
Has the affected person been in close contact with someone with a confirmed case of COVID-19?*
Has the affected person been tested for COVID-19?*
Date of test
Has the affected person been diagnosed with COVID-19?*
Has the affected person been advised of the date to which they need to self isolate?
Dates of isolation
Has the affected person attended classes or work at CIT?*
The affected person consents to the collection of this information*