Volunteer Covid 19 Vaccine Declaration

As a volunteer we deeply appreciate your service to the community at SA Water-managed lands and sites. We want to ensure that your health and safety is protected as you go about your work. From 17 November, vaccination will be mandatory for all of our people to protect their health and safety. This already extends to our business partners, contractors, critical suppliers. We are now extending this requirement to volunteers who work with us.

To enable this, please complete the following declaration. SA Water is bound by the South Australian Government Information Privacy Principles and all personal information collected and held will only be used for the purposes for which it is collected.

Contact Details

Your Name

Email Address

Which SA Water location do you volunteer at?

Declaration

We respectfully request that you provide us with answers to the following questions.

I have received my first vaccination, or will receive it as soon as possible Yes No

I will be fully vaccinated by 24 December 2021 Yes No

If requested on site, I will provide evidence of my vaccination status Yes No

The information you provide in this form is subject to SA Water's Privacy Policy.

Submit