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About Us
Insurance
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Covid-19 Survey
Contact Us
Removals
Household Removals
Office Removals
Interstate Moving
Overseas Moving Services
Storage
Household Storage
Commercial/Business Storage
Mobile Self Storage
Container Storage and Handling
Packing Supplies
Reviews
(08) 8295 4511
Get A Quote
About Us
Insurance
Reviews
Covid-19 Survey
Contact Us
Removals
Household Removals
Office Removals
Interstate Moving
Overseas Moving Services
Storage
Household Storage
Commercial/Business Storage
Mobile Self Storage
Container Storage and Handling
Packing Supplies
Reviews
(08) 8295 4511
Get A Quote
Covid-19 Survey
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Covid-19 Survey
Covid-19 Survey
Jiesie J
2020-07-29T16:15:29+10:00
Details of Your Move
Company Name (If Applicable)
Your Name (If Applicable)
Your Email
Contact Phone Number
Address for the Service at Collection
Address for the Service at Delivery
Expected Date of Contact with Chess
Date of Service if Applicable
Uplift / Collection Date
Delivery Date
Services if Other
Declaration
Is anyone who lives at the service address currently under any form of self-isolation as the result of an order of any government authority or as the result of a recommendation of a health professional?
Yes
No
In the last 14 days, have you or anyone at the service address been in physical contact with anyone who has been diagnosed with the COVID-19 virus?
Yes
No
In the last 14 days, have you or anyone at the service address has been in physical contact with anyone who is in self-isolation due to the COVID-19 virus?
Yes
No
In the last 14 days, have you or anyone at the service address has been in physical contact with anyone who has recently visited any overseas country?
Yes
No
In the last 14 days, have you or anyone at the service address has been in physical contact with anyone who has recently visited or returned from Interstate?
Yes
No
In the last 14 days, has anyone at the service address experienced flu-like symptoms (sore throat, fever, tiredness, and cough) following overseas travel and/or physical contact with someone who has recently returned from overseas?
Yes
No
Consent and Accuracy
I confirm that I have read the
Privacy Collection Notice
and that I consent to provide the information above, which I certify is accurate to the best of my knowledge.
×