University of Melbourne COVID-19 case & contact survey

Privacy collection information

Responses to this form are being collected by the University of Melbourne's Public Health Network to enable a rapid public health response to COVID-19.
Please use this form to report all COVID-19 cases and contacts within the University of Melbourne community.
If you have any questions, please email the Public Health Network at

All information gathered in this form will be managed in line with the University's COVID-19 Privacy Collection Notice.
I consent to the University of Melbourne collecting and processing my personal information for the purpose of preventing and managing the risk of COVID-19 transmission and to ensure compliance with any public health directions which may apply to the University, as described in the COVID-19 Privacy Collection Notice provided.

Your information

Close contact details

For further information about the rules for close contacts please review government guidance

COVID-19 test details

Medical treatments, also known as early therapies or antivirals, are available for eligible people to prevent them from getting so sick that they need to go to hospital. These treatments must be taken as soon as possible after COVID-19 symptoms begin and can be lifesaving. More information about these medicines is available here.

Additional information

Do you work, undertake research, study or live in any of the following settings?

Student accommodation setting

Please select which student accommodation setting you live/work/study in:

Please list the name, email and phone number of each person you share a room with. If they are a University of Melbourne student or staff member, please include their University email address

Health or clinical setting

Childcare setting

Your University attendance

Where have you been

Please provide details of where you attended within the 48 hours prior to your first symptoms or positive test
Attendance details

See for guidance

View MyTimetable or your subject’s Timetable tab in the University Handbook for guidance in completing the following information

e.g. Lecture 1, Tutorial 3