Public Health and Wellbing Act 2008

COVID-19 Check-in
Name of place

Location e.g. courtyard, dining room

QR Code Check-in continues to be the most effective record keeping system.*

In the event of a COVID-19 outbreak, Victoria’s contact tracers can only do their job if they can 

contact you quickly.

Help keep each other safe by writing your contact details down here.

Learn more about the Service Victoria app and checking in online at service.vic.gov.au/check-in

*Manual record keeping should only be used in exceptional circumstances.

Date of visit
 Given name

Family name
Contact number Arrival time

DD/MM/YY
e.g. 9:32am

Protecting your privacy: Your Given name, Family name, contact phone number, and time of visit at this location is being collected by the
Victorian Government for the purposes of contact tracing during the coronavirus (COVID-19) pandemic. Your check in information will only
be used or disclosed for contact tracing. Otherwise your data will be deleted within 28 days. Your details can’t be used for marketing or
other purposes or kept by this venue. If you choose not to leave your details by checking in, venues may refuse you entry. It will also be
harder for us to contact you if there’s a new COVID-19 case near where you checked in. Read the full details about how we protect your
information and handle the information we collect at service.vic.gov.au/check-in-privacy