Declaration and Service Report

Health Declaration

  • Self-declaration records will be used and disclosed for managing site access and as required by law.

  • Are you CURRENTLY experiencing any of the following symptoms? Loss of smell, loss of taste, cough, sore throat, fatigue, aches and pains, shortness of breath, runny or stuffy nose, headaches or raised temperature.

  • Have you been in a declared hotspot area?

  • In the past 14 days have you returned from travel outside of Australia?

  • Have you recently been in contact with someone diagnosed with coronavirus to your knowledge?

  • Are you, or someone you are living with, awaiting a Covid19 test result?

  • Have you been in close contact with someone awaiting the results of COVID-19 testing within the past 14 days?


  • What is the site name?

  • What time did you start the service?

  • What time did you finish the service?

Sanitising Cleaning Process

  • Have you read the Safe Work Method Statement 014 Sanitising Cleaning?

  • Did you wear gloves while conducting the sanitising work?

  • Do you use clean disposable cloths to sanitise surfaces?

  • To sanitise correctly, the surface must be cleaned immediately before applying sanitising chemical. Have you cleaned the surfaces to be sanitised?

  • Effective sanitisation requires the use of approved chemical, used in the correct dilution rate and allowed to dwell on the surface for the correct amount of time. Have you used the sanitising chemical correctly according to the manufacturers instructions for sanitising?

  • Did you either dispose of or wash out (with warm water) cleaning cloths at the completion of service?

  • Did you remove all waste at the completion of service?

Sanitising Requirements

  • Cleaning and sanitising to prevent the spread of disease requires routine environmental cleaning. It is good practice to routinely clean surfaces. Frequently touched surfaces should be cleaned daily or more frequently depending on the nature of the workplace (e.g. shift changes, shared facilities). Minimally touched surfaces (floors, ceilings, walls, blinds etc) should be routinely cleaned. In addition, surfaces should be cleaned immediately after any spillage or where visibly soiled.

  • Have you cleaned and sanitised frequently touched surfaces?

  • With reference to the Worksheet, have you completed all the duties requested?


  • By signing this report I declare that I have followed the procedures for sanitising cleaning, that I have completed the work requested in the Worksheet and that I have truthfully answered all questions herein.

  • Name and signature of Cleaner

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