COVID-19 Close Contacts Spreadsheet for Victorian Workplaces

Instructions:
Please complete all tabs and email to COVIDEmployerNotifications@dhhs.vic.gov.au if you have confirmed case/s of COVID-19 in your work premises.
To be used in conjunction with the Employer COVID-19 Notification Form, Workplace Risk Assessment and associated guidance.
Please instruct all close contacts to self-isolate at home for a full 14 days from the last date of contact with an infectious confirmed case, even if they return a negat

Close contact definitions:

Close contact means any contact greater than 15 minutes face-to-face (or within 1.5m radius), cumulative, or the sharing of a closed space for more than 2 hours,
Contact needs to have occurred during the infectious period, which is 48 hours (or 2 calendar days) prior to symptoms developing (or if no symptoms, 48 hours or 2

Examples of close contact could include:

* 5 minute chat in hallway + 10 minute car ride + 1 minute in lift = close contact (calculated over the entire infectious period)
* being in the same office space, shared work zone or meeting room for 2 hours or more (calculated over the entire infectious period)

Please fill in each of the following tabs (found at the bottom of this spreadsheet):
Facility Details
Positive Case Details
Close Contacts

Resources:
For more information on COVID-19 symptoms, please refer to:
https://www.dhhs.vic.gov.au/victorian-public-coronavirus-disease-covid-19

For general COVID-19 information, please refer to:

https://www.dhhs.vic.gov.au/coronavirus
rk premises.

n if they return a negative test (swab) during this period.

for more than 2 hours, cumulative, with a confirmed case during their infectious period.
ymptoms, 48 hours or 2 calendar days prior to COVID-19 test date).
Facility details
Facility name Address
Contact person's name Contact person's mobile number
Contact person's email
COVID-19 confirmed case/s details
First Name Last Name Date of birth
Mobile number Email
Dates worked whilst infectious Shift times worked
 Other jobs/work premises where the
Area/s worked in
case works
PHESS ID of +ve caes (DHHS to complete)
Close Contacts - full list of close contact staff, residents, visitors, contra
First name Last name Date of birth Street Address
visitors, contractors, students, workplace inspectors etc.
Suburb Postcode Email
 Aboriginal and/or Torres Strait
Mobile phone Language spoken
Islander status (if known)
Role in organisation: (e.g. staff, residents,
visitors, visiting staff, students, workplace Date of last contact with confirmed case/s
inspectors)
 Where did contact occur? (e.g. break room,
Nature of contact (e.g. visitor, cared for them)
shared office, carpooling etc)
Has this person been notified that they are a close contact of a confirmed case?
(Yes/No)
Date tested: (if known) Results: (if known) Comments: