Declaration for Health,
Engineering and Sciences
Student Placements:
I, ________________________________________
Student Number: _______________
Placement Course Code: ___________
declare the following to be true and correct:
At the time of making this Declaration, I have not been diagnosed with COVID-19
If during the 14 days prior to the commencement of this placement, I am
diagnosed with COVID-19 (Coronavirus), I will notify as
soon as possible prior to the commencement of this placement.
If I commence a period of 14 days self-isolation or quarantine prior to my
placement, I will notify as soon as possible.
I acknowledge the requirement to follow advice from the Australian Government
Department of Health with respect to COVID-19.
Signature of student: __________________________Date: _________
I am commencing a placement on (specify date)
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