Covid-19 Questionnaire - Meeting Entry Permit

Due to the COVID-19 pandemic, the QHMC Management are taking these extra precautions to protect all attending QHMC meetings and ensuring QHMC complies with the Veteran Car Club Rooms Covid-Safe Plan.

This form must be completed by ALL Delegates and Visitors entering the premises at 1376 Old Cleveland Road from 7:00pm to 10:00pm during the Queensland Historic Motoring Council meeting, held on the 4th Thursday of each month (except December).

This completed form must be received by QHMC Secretary no later than 7:00pm on the day prior to the meeting. If you do not submit your completed Questionnaire prior to each meeting, you are unable to attend the monthly QHMC General Meeting or Annual General Meeting. (This is also to ensure QHMC do not exceed the maximum number of allowed attendees.)

You are to bring a copy of this form with you to the meeting. It will be passed to the authorised person at the entrance.

If you submit online (below), get a copy by:

Printing your confirmation email, or
Printing this page before submitting.

No completed form - no entry.

First Name: required

2–50 characters: ALPHABET, SPACE, HYPHEN, APOSTROPHE only.

Surname: required

2–50 characters: ALPHABET, SPACE, HYPHEN, APOSTROPHE only.

Phone Number: required

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Email Address: required

Enter your email address. Did you mean: ?

Street Address: required

Enter your street address.

State: required

Post Code: required

Just 4 digits.

Delegate of (Club):

Leave blank, OR 3–50 characters: A-Z, 0-9, & PUNCTUATION only.

Have you currently, or within the last fourteen (14) days had a fever, cough, runny nose, sore throat, fatigue, aches and pains, headaches, diarrhoea, shortness of breath or breathing difficulties?

required

Have you been in contact with a known or possible case of COVID-19 in the last 14 days?

required

Have you travelled to a COVID-19 Hotspot or overseas within the last 14 days?

required

Have you travelled overseas or been on a cruise ship within the last 14 days?

required

I declare the above information is true and correct.

Tick "I'm not a robot" and complete the anti-spam challenge.

The submit button will be enabled when there are no more red hints above. Click the button to send!

If you have answered "YES" to any of the questions above, you will be denied access to the premises.

TEMPERATURE CHECK

NOTE — QHMC committee have the right to conduct a temperature check before you enter the premises for the QHMC General Meetings and Annual General Meeting.

It is generally medically accepted that normal body temperature ranges between 36.5 - 37.5°C.

If your temperature records above 37.5°C, you will not be permitted to enter the premises; and it will be recommended you have yourself tested for COVID-19.

Alternate Lodgement

Printable/Offline Version of the Permit Form	Downloadable PDF
You may send the completed offline form to: