COVID-19 Declaration – Department of Transport and Main Roads (TMR)

Covid-19 Vaccination Status

As you would be aware, some construction sites have issued a COVID-19 Mandatory Vaccination Policy for all contractors working on these worksites.

The Department of Transport and Main Roads (TMR) has implemented a COVID 19 Vaccination Policy. This requirement is for ALL workers, contractors, consultants and visitors to be fully vaccinated if they are required to enter a TMR workplace and will be in place from 21 February 2022, with a first dose requirement date of Monday 28 February and a second dose requirement date of Monday 11 April 2022.

These directions require that, as of 11:59pm Sunday 10 April 2022, worksites must ensure that workers do not enter or remain on TMR worksites unless they have provided or can present evidence of at least of the following:

1. The worker has received two doses of COVID-19 vaccine (via their ‘COVID-19 digital certificate’ available from Services Australia or MY GOV)

2. The worker has received one dose of COVID-19 vaccine prior to Monday 28 February 2022 (via their ‘Australia Immunisation Register’ record provided at their vaccination or MY GOV)

3. The worker has a booking to receive a second dose of COVID-19 vaccine before Monday 11 April 2022 (via a booking confirmation)

4. The worker has a medical exemption (via a medical certificate/letter from an authorised medical practitioner). Please note that the exemption must be issued form a certified medical practitioner.

As such, the person completing this form must ensure and declare that the information provided is true and accurate. This form must be completed, with all requested supporting documentation, within the next 24 hours.

Please complete the TMR COVID 19 declaration as per below and submit as a matter of urgency.

Department of Transport and Main Roads (TMR) - COVID Declaration

Name of person providing this Declaration*
First Last
Mobile Number*
Email*
Company Name*
(Please note: this is the company you are employed by, not EPH)
Your Current Covid-19 Vaccination Status:*
- Received a full COVID-19 vaccination
- Partial COVID-19 vaccination
- Have made a booking to receive my second dose of a COVID-19 vaccine by 11 April 2022
- Cannot receive a COVID-19 vaccine which is supported by a medical exemption
Please upload the required evidence of your Covid-19 Vaccination status:*
The workers COVID-19 digital certificate is available from Services Australia
(Condition: No expiry on full COVID-19 vaccination certificate)
Drop files here or
Max. file size: 256 MB.
Please upload the required evidence of your Covid-19 Vaccination status:*
The workers Australian Immunisation Register (AIR) record which includes all immunisations, including the date and brand of COVID-19 vaccine you have received.
(Condition: Partial COVID-19 vaccination records are only valid for 4 months. Therefore, if an employee only has evidence of their first vaccination, they must receive and provide evidence of their second vaccination within four months of their first vaccination to ensure this job title stays active and allow for site access)
Drop files here or
Max. file size: 256 MB.
Please upload the required evidence of your Covid-19 Vaccination status:*
Booking confirmation for the worker from the medical clinic performing the COVID-19 vaccination.
(Condition: If a booking email is provided in place of the second vaccination, this competency would have the date of booking as the expiry. Therefore, if the employee does not attend the booking or has to reschedule the booking email would become invalid until a new booking confirmation is uploaded to the system and site access would be denied until such time)
Drop files here or
Max. file size: 256 MB.
Medical Exemption - Please upload the required evidence of your Covid-19 Vaccination status:*
Medical exemption issued for the worker from a medical practitioner that is authorized to grant exemptions.
(Condition: Medical exemption will be assessed by TMR Safety Team and Legal teams for validity)
Drop files here or
Max. file size: 256 MB.
I also hereby declare that:*
- I understand my duty of disclosure, and that EPH will take this Declaration to be true and accurate.
And*
- I declare that the information I have provided belongs to me
Operator Declaration*
- I have read and understand the declaration as above and I consent to providing my information to TMR.
Signed by*
Please type your name
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