Your name
Arrival Date
Departure Date
Address
Contact Number
Email
Have you been vaccinated?
How Many guests will be staying at the property?
Please list each guest name (please include first and last names)
Are any guests 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 YesNo Has any guest returned from travel outside of Western Australia in the past 14 days YesNo Has any guest been in close contact with a person who has returned to Australia in the last 14 days or potential contact with someone that is suspected to have COVID-19? YesNo Has any guest been exposed to anyone that is suspected or confirmed to have COVID-19? YesNo Declaration I hereby declare that the details above are true and correct to the best of my knowledge and I undertake to inform you of any changes therein immediately. I understand further that I will advise Busselton Motel if any of my guests show symptoms or are diagnosed with Covid 19 following your departure.
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