ESSENTIAL TRAVELLER - RECORD OF CLOSE CONTACT*These records must be retained and if requested, be produced to an Authorised Officer

as proof of compliance with Directions issued pursuant to the Emergency Management Act, 2004.

Name of Close Contact Phone Number Date / Time Location of Close Contact

This form can be downloaded at www.sa.gov.au V1 as at 9/05/2020

ESSENTIAL TRAVELLER - RECORD OF CLOSE CONTACT*These records must be retained and if requested, be produced to an Authorised Officer

as proof of compliance with Directions issued pursuant to the Emergency Management Act, 2004.

Name of Close Contact Phone Number Date / Time Location of Close Contact

This form can be downloaded at www.sa.gov.au V1 as at 9/05/2020