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COVID-19 

Information for Residential Aged 

Care Facilities 
 

Visitors screening checklist 
This checklist supports operators of residential aged care facilities (RACF) to screen visitors  eligibility 
for entry into RACFs, based on the requirements of the current RACF Direction made under the 

Emergency Management Act 2004. 

Visitors screening checklist  

Temperature check _______ degrees Celsius    
 

If your temperature is higher than 38 degrees Celsius, entry will not be permitted 

Influenza vaccination  
? I have been vaccinated against 2022 seasonal influenza and have provided proof of vaccination 

to the facility (from 10 June 2022) 
 
If you have not been vaccinated against 2022 seasonal influenza, entry will not be permitted 
unless you have an exemption as listed below: 

? infants too young to be vaccinated (6 months or less); 

? exceptional end of life circumstances (the person who is not able to access the influenza 
vaccine before their visit to the RACF should take all reasonable steps to access the 
vaccine after their initial visit); 

? a person who has a medical contraindication to the influenza vaccine endorsed by the 
Chief Public Health Officer or her delegate; 

? a person who is following the recommended 7 days waiting period between receiving the 
COVID-19 vaccine and the influenza vaccine (the person will need to provide evidence of 
the date of receipt of a COVID-19 vaccination to the RACF and take all reasonable steps 
to ensure they are vaccinated as soon as is reasonably practicable); 

? a person to whom the vaccine is not reasonably available; and  

? emergency situations. 

COVID-19 vaccination 
? I have been fully vaccinated against COVID-19 and have provided proof of vaccination to the 

facility  
 

? From 6 December 2021, you must be vaccinated against COVID-19 in order to visit a 
RACF in SA. From 29 January 2022, this includes two doses of a COVID-19 vaccine and 
a booster vaccine if you are eligible. 

 
If you have not been fully vaccinated against COVID-19, entry will not be permitted unless you have 
an exemption as listed below: 

? people too young to be vaccinated (12 years &amp; 2 months or less); 

? exceptional end of life circumstances (the person who is not able to access the COVID-19 

Name: Telephone:  

Date: Time in: Time out: 

Area / Patient / Resident visiting: 

? COVID Safe QR check-in completed 

? Hand hygiene completed  

? Surgical mask provided (to be worn at all times, unless child aged 12 years or less) 

? RAT Test administered (Optional) 



 
COVID-19 

Information for Residential Aged 

Care Facilities 
 

vaccine before their visit to the RACF should take all reasonable steps to access the 
vaccine after their initial visit); and 

? a person who has a medical contraindication to the COVID-19 vaccine endorsed by the 
Chief Public Health Officer or her delegate. 

? I have not been in contact with a confirmed COVID-19 case within the last 14 days (unless 
appropriate PPE was worn). 

? I have not visited any exposure locations (in SA or interstate) at the dates and times listed 
by the jurisdiction (refer to SA Health exposure locations webpage) 

 

If you are a close contact, entry will not be permitted for 14 days following exposure, unless attending 

for end of life circumstances. 

? I have not been directed to quarantine or isolate for any reason in the past 14 days. 
 

If directed to quarantine or isolate, entry will not be permitted, unless you have a specific 

exemption. 

? I am not awaiting the results of a COVID-19 test. 
 

If you are awaiting a COVID-19 test result, entry will not be permitted unless you undertook the test 

for routine surveillance testing and do not have COVID-19 symptoms. 

? I have not had a history of any of the following symptoms in the last 72 hours: fever, chills, 
symptoms of an acute respiratory infection such as a cough, sore throat or shortness of breath, or 
loss of taste and smell in the last 14 days. 

 

If you have had symptoms in the last 72 hours, entry will not be permitted. 

 

 

 

For more information 

Office for Ageing Well   

Department for Health and Wellbeing 

SA Health, Government of South Australia  

www.sahealth.sa.gov.au/covidagedcare 

Last updated 24 May 2022     

  Department for Health and Wellbeing, Government of South Australia. All rights reserved.  

 

Visitor name:             Signature:    

Staff member name:       Signature:   




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