COVID-19 Contact Tracing Record

All participants entering the the lake must sign in on the CONTACT TRACING RECORD and provide the date and time that they attended Speed Week as well as their name, phone number, and email address. This information will be used for the purposes of contract tracing only and will not be shared or sold to a third party. If you cannot or choose not to provide your details and sign the agreement, access to the event will respectfully be refused.

If you cannot use this form, you can download a CONTACT TRACING RECORD page.

 

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. They may only be used for the purpose of contact tracing in relation to COVID-19.

  • * Date(s):
  • * Time(s):
  • * Name:
  • * Phone:
  • * Email
  • * Location:
  • * COVID-19 Declaration:

 

* Mandatory information

Communicable Disease Waiver / Release Agreement
ASSUMPTION OF RISK / WAIVER OF LIABILITY / INDEMNIFICATION AGREEMENT
To be agreed to by all Speed Week participants.
The DLRA have put in place a management plan to reduce the spread of COVID-19, flu, pneumonia, and other communicable diseases. However, the DLRA cannot guarantee that you will not become infected with COVID-19, flu, pneumonia, and other communicable diseases. Further, attending Speed Week could increase your risk of contracting COVID-19, flu, pneumonia, and other communicable diseases. By signing this agreement, you acknowledge the contagious nature of COVID-19, flu, pneumonia, and other communicable diseases and voluntarily assume the risk that they may be exposed to or infected by COVID-19, flu, pneumonia, and other communicable diseases by attending Speed Week and that such exposure or infection may result in personal injury, illness, permanent disability, or death. You understand that the risk of becoming exposed to or infected by COVID-19, flu, pneumonia, and other communicable diseases at Speed Week may result from the actions, omissions, or negligence of themself and/or others, including, but not limited to, DLRA officials, volunteers, spectators, entrants, crew members, and their families.

By signing this agreement, each signatory will agree to abide by the contingencies put in place by the DLRA and the rules and Regulations of the Government of South Australia.

You also affirm that if they are diagnosed with, demonstrate any symptoms of or have in any way been exposed to COVID-19, flu, pneumonia, or other communicable diseases within fourteen days prior to Speed Week that you will not travel or attend Speed Week and if you do contract COVID-19, flu, pneumonia, and other communicable diseases whist at Speed Week you will immediately report to the DLRA Chief Medical Officer.

This information will be used for the purposes of contract tracing only and will not be shared or sold to a third party.

If you cannot or choose not to provide your details and agree to the agreement, access to the event will respectively be refused.

 

Select "Send" ONCE ONLY