Westgate Tunnel Declaration

Covid-19 Vaccination Status

As you would be well aware the Victorian Government has issued a COVID-19 Mandatory Vaccination Direction that has been issued for all constructions worksites across Victoria.

CPB John Holland JV along with the Victorian Government issued a new Public Health Directions, effective as of Friday 17 September 2021. These directions require that, as of 11:59pm Thursday 23 September 2021, Construction worksites must ensure that workers do not enter or remain on the Westgate construction site 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 (via their ‘Australia Immunisation Register’ record provided at their vaccination or MY GOV)

3. The worker has a booking to receive a dose of COVID-19 vaccine before Saturday 2 October 2021 (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 WGTP declaration as per below and submit as a matter of urgency.

Westgate 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)
Damstra Number*
Your Current Covid-19 Vaccination Status:*
- Received a full COVID-19 vaccination
- Partial COVID-19 vaccination
- Have made a booking to receive a dose of a COVID-19 vaccine by 2 October 2021
- 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.
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 WGTP 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 Damstra & Westgate Tunnel Project
Signed by*
Please type your name
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