COVID-19 Health Declaration Form

This daily health declaration is required to enable your access to all Victorian RMIT campuses or RMIT-related work placement location as directed by the Department of Health and Human Services.

Prior to submitting this form please ensure you have completed your RMIT COVIDSafe 2021 training module. For students please click here to access your Canvas COVIDSafe training, for staff please click here.

The information you provide will be treated as confidential and managed in line with RMIT’s Student Privacy Statement and/or Staff Privacy Statement.

To pre-fill your details, please Log in.

Your Details

Given Name

Surname

Staff or Student Number

Please omit 's' from student number.

RMIT Email

To make updates to personal details, students can access Enrolment Online, while staff can visit Worklife for more information.

Declaration

1. I am free of COVID-19 symptoms including the below.

COVID-19 symptoms include the following:

Loss or change in sense of smell or taste
Fever
Chills or sweats
Cough
Sore throat
Shortness of breath
Runny nose

2. I have not been in contact with a confirmed case of COVID-19.

3. I have not been directed to isolate in the last 14 days.

Contact Number

Numerals only, no spaces

For the purposes of DHHS contact tracing, have you worked in a sensitive setting such as hospitals, residential aged care facilities, home-based care, and disability services in the last 14 days?

YesNo