Queensland Border Declaration Pass

1 Queensland Border Declaration pass In response to the COVID-19 pandemic, entry to Queensland is temporarily restricted by the Chief Health Officer under the Border Restrictions Direction. You are only allowed to enter Queensland if you are an exempt person or have been granted an exemption from Queensland s Chief Health Officer AND you have a Queensland Border Declaration pass . Freight transport drivers are not required to complete the Queensland Border Declaration pass . A separate Declaration pass is required for each individual, including children, and all travelers in your party must be eligible to enter Queensland . If an individual seeking to enter Queensland is a child or a person with impaired capacity, a parent or guardian may complete this form on behalf of the person. Once your Queensland Border Declaration pass is approved you will need to enter Queensland within 7 days.

2 If you don t you will need to apply for a new Queensland Border Declaration pass . Please note, access to remote communities is currently restricted by the Chief Health Officer. A separate Communities Entry pass is required for travel to a designated area (remote communities). You will need both a Queensland Entry pass AND Communities Entry pass if your travel involves both a Border crossing and entry to a designated area. Are you: An exempt person under the Border Restrictions Direction (please tick below which categories apply): Queensland resident who has ordinarily been a resident of Queensland since 29 January 2020 (start of the declared public health emergency) New resident relocating to Queensland Cross- Border resident Queensland Ambulance Service employee, paramedic, an officer of St John Ambulance australia , RACQ Lifeflight crew, Royal Flying Doctor Service crew or other aeromedical services crew providing medical care or transport to a patient in Queensland A person responsible for the retrieval, delivery or transportation of organs or tissue A person responsible for providing health support services for the maintenance, resupply or repair of health services infrastructure critical to Queensland Australian Red Cross Lifeblood Emergency Services worker A Government official responsible for the safety of australia or Queensland against threats such as terrorism, war or espionage.

3 And is required to be present in Queensland for such purposes Active military personnel required to be on duty in Queensland while in Queensland Active member of the Australian federal Police or Australian Border Force required to be on duty while in Queensland A federal , State or local government elected representative who is travelling to Queensland to perform official duties in Queensland A member of a State or Commonwealth law enforcement agency required to be on duty while in Queensland Consular employees as defined in the Consular Privileges and Immunities Act 1972 (Cth) travelling to Queensland to perform official duties in Queensland Worker critical to key infrastructure, services, utilities, government, industries or businesses FIFO worker for the critical resources sector Agribusiness or commercial fishing worker Higher Education students or staff members Escaping injury or harm Compassionate grounds or compulsion of law Domestic air transit passenger (transiting onto another flight out of Queensland or a person arriving at the Brisbane or Gold Coast airport who will transit directly by road to New South Wales) Chief Health Officer exemption (written evidence must be carried at all times and be presented upon request by a police officer or other authorised officer) Has every other person you are entering Queensland with completed a Queensland Border Declaration pass ?

4 Yes No Do you have a diagnosed case of COVID-19? Yes No Have you returned from travel outside of australia in the past 14 days? Yes No Have you had known contact with a person who has a confirmed case of COVID-19 in the past 14 days? Yes No Have you had any symptoms consistent with COVID-19 in the past 14 days? (Such as fever, cough, shortness of breath, sore throat or loss of smell or loss of taste) Yes No Have you travelled in the last 14 days to a place identified as a COVID-19 hotspot? Yes No If yes: 1. Are you a specialist worker required to be in Queensland to perform specialist work (please tick the below category that applies)? To be a specialist worker you must be providing time critical services, that cannot be provided by anyone in Queensland , and that you cannot provide remotely. Queensland Ambulance Service employee, paramedic, an officer of St John Ambulance australia , RACQ Lifeflight crew, Royal Flying Doctor Service crew or other aeromedical services crew providing medical care or transport to a patient in Queensland A person responsible for the retrieval, delivery or transportation of organs or tissue A person responsible for providing health support services for the maintenance, resupply or repair of health services infrastructure critical to Queensland Australian Red Cross Lifeblood Emergency Services worker A Government official responsible for the safety of australia or Queensland against threats such as terrorism, war or espionage.

5 And is required to be present in Queensland for such purposes Active military personnel required to be on duty in Queensland while in Queensland Active member of the Australian federal Police or Australian Border Force required to be on duty while in Queensland A member of a State or Commonwealth law enforcement agency required to be on duty while in Queensland A federal , State or local government elected representative who is travelling to Queensland to perform official duties in Queensland Consular employees as defined in the Consular Privileges and Immunities Act 1972 (Cth) travelling to Queensland to perform official duties in Queensland Transport worker Specialist worker critical to key emergency services, government, industry or business continuity where the worker needs to be physically present in Queensland , the services are not available in Queensland and their services need to be provided without delay 2.

6 Did you transit directly through the COVID-19 hotspot without stopping? Yes No 3. Are you required to enter Queensland under the orders of a Court or Tribunal? Yes No 4. Can you provide evidence that you are travelling to Queensland to assist with or participate in a Commonwealth or State investigation or other action by law enforcement? Yes No 5. Can you provide evidence that you completed 14 days of government-approved quarantine in another state or territory of australia immediately before entering Queensland ? Yes No Please complete the following details: First Name: Last Name: Street address: Town, city or suburb: State: Postcode: Email address: Where do you intend to stay in Queensland ? Please complete the following Declaration : I declare that the information I have provided in this form is true and correct to the best of my knowledge.

7 I acknowledge that knowingly providing false, misleading or incorrect information is an offence under the Public Health Act 2005 punishable by a fine of $4,004 or a court-imposed penalty of up to $13,345. Signature: Date: Privacy notice: The information collected on this form is collected by the Queensland Government for the purpose of responding to a declared public health emergency under the Public Health Act 2005 and may be shared with other government agencies for that purpose. You are allowed to access your information. If you wish to access or correct your any of the personal information on this form or discuss how it has been dealt with, please contact Queensland Health. Details about how to contact Queensland Health, or to learn more about how they deal with your confidential information and how you can access your information can be found at: and