This form is to be completed by a person, or by a parent, legal guardian or power of attorney on behalf of a child (under 18 years) or on behalf of an adult with impaired capacity, who believe they have been correctly identified as a close contact of a COVID-19 case through information obtained during contact tracing resulting in the identification of close contact venues.
Privacy notice
Personal information is collected in this document by or for Queensland Health, which includes the Department of Health and the Hospital and Health Services, for the purpose of responding to a declared public health emergency under the Public Health Act 2005 and may be shared with other Queensland Government departments and agencies for that purpose. Queensland Health may use your personal information for the purposes of contact tracing, administering quarantine requirements, or for another purpose related to COVID-19.
All personal information will be handled in accordance with the Information Privacy Act 2009 (Qld). Personal information provided by you will be securely stored and only accessible by appropriately authorised officers. Personal information recorded in this document will not otherwise be disclosed to other parties without your consent, unless the disclosure is authorised or required by under law.
If you are providing personal information on behalf of another person, you are required to inform them of this privacy statement and that their personal information has been collected.
If only part of your personal information or no information is provided, then we may not be able to contact you and you, or the person who you have completed this form on behalf of, may not comply with your obligations under the Public Health Act 2005.
For information about how Queensland Health protects your personal information, or to learn about your right to access your own personal information, please see our website at https://www.health.qld.gov.au/global/privacy.