Student Health Self-Declaration Form


Student Health Self-Declaration Form


Student Health Self-Declaration Form

The health declaration form is meant to document illness or possible exposure to COVID-19. It is required in order to safeguard the health and safety of students and staff, and to restrict the outbreak within the Swinburne community, and the general population.

Your online submission of the completed form will be forwarded to Swinburne’s COVID-19 Taskforce, and your respective lecturers will be notified accordingly. The COVID-19 Taskforce will manage each case and update you on your next course of action, where required.

You are required to fill in the form if you fall into one of the categories described below:

Category 1: COVID-19 Patient

  • Student who has tested positive for COVID-19 by the relevant authorities.

Category 2: Person Under Investigation (PUI)

Student is identified as Person Under Investigation (PUI) when:

  • Student have fever OR acute respiratory infection (sudden onset of respiratory infection with at least one symptom below.
    • Shortness of breath
    • Cough
    • Sore throat


  • Travelled to or reside in affected countries in the 14 days before the onset of illness OR in close contact in 14 days before onset of illness with a confirmed case of COVID-19.

Category 3: Close Contact

Student is identified as Close Contact i.e. person who has been in contact with a confirmed COVID-19 patient. This close contact may involve the following:

  • Working together in close proximity or sharing the same classroom environment with a confirmed COVID-19 patient
  • Travelling together with a confirmed COVID-19 patient in any kind of conveyance including public transport
  • Living in the same household as a COVID-19 patient
  • Health-care associated exposure without appropriate Personal Protection equipment (PPE) including providing direct care for COVID-19 patients, working with health care workers infected with COVID-19, visiting patients or staying in the same closed environment with a COVID-19 patient.

Category 4: Self Quarantined (Self Declared)

Students wo requests for self-quarantine as a precautionary measure due to:

  • Uncertain of own condition or any other circumstance.

Category 5: Self Quarantine / Stay Home Notice (SHN) (Medical)

  • Student who has been asked to Self-Quarantine by Kementerian Kesihatan Malaysia / medical personnel.

Category 6: Stay Home Notice (Travelling back to Sarawak)

  • Student who is issued a Stay Home Notice by the authorities upon returning to Sarawak.

The form can be accessed here:

For more information or clarification, contact studentHQ at sic@swinburne.edu.my.