COVID -19 (novel coronavirus) Entry into Designated ... into Designat… · Gov West Austr t A...

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Year Day Month Place of entry into Designated Biosecurity Area:

Date and time of arrival

Last location before entering Designated Biosecurity Area (Region of Western Australia; State/Territory of Australia):

If entering from outside WA, you will also need to complete the WA entry – Request for Approval as an Exempt Traveller form available at https://www.wa.gov.au/government/publications/wa-entry-request-approval-exempt-traveller

If by plane If by boat/ship If by road If by rail

Contact details

Health and travel history requirements

Accommodation address for the next 14 days

Driver’s licence number

Email

Day Month Date of birth

Nationality (as shown on passport) Name

Flight number Seat number Vehicle Registration Name of Vessel Train number Seat number

COVID-19 (novel coronavirus) - Entry into Designated Biosecurity Areas (Kimberley, East Pilbara, Ngaanyatjarraku) Failure to comply with the Biosecurity (Human Biosecurity Emergency) (Human Coronavirus with Pandemic Potential) (Emergency Requirements for Remote Communities) Determination 2020, made under the Biosecurity Act 2015 (Cth) is an offence punishable by a fine of up to $63,000 for individuals and/or imprisonment up to 5 years.

Details of travel Time : am/pm

Mobile number

Country(ies), States and Territories visited in the past 14 days (please give dates for each):

You are not allowed to enter the Designated Biosecurity Area if any of the following applies to you (unless you are escaping an immediate threat to life, or are an authorised biosecurity officer or a member of the Australian Defence Force travelling on duty).

Tick if any of these applies to you or any other people travelling with you who are not completing their own forms. See end page for full definitions.

Been exposed to a person with human coronavirus, without adequate personal protective precautions in the last 14 days

Currently showing Symptoms (see Definition section)

Details:_______________________________________________________________________________________

____________________________________________________________________________________________

______________________________________________________________________________________________________

Travelled overseas in the last 14 days

Entry into Designated Biosecurity AreasProtecting yourself and others from coronavirus

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You may only enter the Designated Biosecurity Area if you – and all the people you are travelling with – meet at least one of the following criteria and the health and travel history requirements on the previous page.

Restrictions on entry

If none of these apply to you and you wish to apply for a Special Permission, please complete the attached form.

Self-isolation before entry No prior self-isolation

You will transit through the Designated Biosecurity Area using the most direct practicable route, and not come into contact with another person

You are travelling directly from a Designated Biosecurity Area in the NT or SA and are an exempt traveller authorised to enter WA; or

You are engaged in (or transporting people engaged in) an Essential Activity that requires you to be in the area (see Definitions section); or

You are escaping an immediate threat to your life You are travelling for a Permitted Purpose (see Definitions section) and for the last 14 days you have:

• been isolated from the general public (see Definitions section); and

• not had any Symptoms of human coronavirus (see Definitions section)

Give details of the situation you have ticked. You may be asked to give further evidence. If you are travelling for an Essential Activity and have not completed 14 days self-isolation, give the name of the business, agency or person who has received approval from a human biosecurity officer for an applicable risk management plan or explain why your travel is urgent.

Tick which situation(s) applies to you and the people you are travelling with.

You are travelling for a Permitted Purpose and:

You are travelling in your capacity as a member of the Australian Defence Force or an authorized biosecurity officer (see Definitions section)

WA.gov.au

13 COVID 13 2 6 84 3

For more information visit WA.gov.au or call

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Your obligations after entering the Designated Biosecurity Area

Every person entering the Designated Biosecurity Area is required to comply with the relevant directions under the Public Health Act 2016 (WA) and the Emergency Management Act 2005 (WA) intended to limit the spread of human coronavirus. Every person entering the Designated Biosecurity Area without self-isolating for 14 days, must take reasonable steps to minimise their exposure to other people in the area.

Travellers from interstate may be given a quarantine direction by an authorised officer, or may be subject to other quarantine or isolation requirements (for example FIFO workers).

Travel between Kimberley shires: In addition to the restrictions on entry into the Designated Biosecurity Areas, travel between shires in the Kimberley region is restricted under the Emergency Management Act 2005 (WA). You should familiarise yourself with these restrictions before making travel plans.

Travel between the Kimberley, East Pilbara and Goldfields-Esperance regions: Further restrictions apply to travel between regions of Western Australia within the Designated Biosecurity Area. You should familiarise yourself with these restrictions before making travel plans.

Travel to remote communities: Further travel restrictions apply to remote Aboriginal communities in Western Australia. You should contact the relevant community before travelling.

Failure to comply with these State restrictions is an offence punishable by a maximum of 12 months imprisonment or a fine of up to $50,000 for individuals and $250,000 for bodies corporate. These restrictions can be found at: https://www.wa.gov.au/soedeclarations

Declaration I declare that: • I have read and understood this form;

• I understand that the categories of Permitted Purposes must be read in the context of the relevant directions restricting travel to Western Australia and within Western Australia;

• I have read and understood the meaning of the term Permitted Purpose by having read the Directions that apply to my travel; and

• The information I have provided is not false or misleading in any respect.

I acknowledge that the provision of false or misleading information may constitute an offence punishable by a fine or imprisonment.

This information is required for the purposes of the Biosecurity Act 2015 (Cth). The information is collected and will be used for the purposes of assisting the Chief Human Biosecurity Officer and/or human biosecurity officers to exercise their powers and perform their functions under the Biosecurity Act 2015 (Cth) in relation to the novel coronavirus COVID-19. The information may also be used for the purpose of assisting the State Emergency Coordinator and the Chief Health Officer in the exercise of their powers, and performance of their functions, under the Emergency Management Act 2005 (WA) and the Public Health Act 2016 (WA) respectively in relation to the novel coronavirus COVID-19.

Year Day Month Signature

When you have completed the form:

• Please give it to an officer authorized under the Emergency Management Act 2005 (WA); or

• Email it to [email protected]

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Additional people travelling information If you are travelling together with family members, minors or other persons who are unable to complete their own form, please provide the names and contact details of each additional person below:

Additional person details 1




Email (Separate contact details not required if traveller is under 18 and travelling with an adult) Mobile number

Date of birth Day Month

Name



Name



If by plane or rail, seat number Name



Name

Important Information: If there are more than four people travelling, please complete an additional form for the remaining passengers

If by plane or rail, seat number



For Office Use OnlyAuthorised / Responsible Officer

Name

Regiment Number

Time / Date of Decision

Approved Not Approved

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WA.gov.au

Further information • Definitions

• Travel for a “permitted purpose’ - Travel within Western Australia - Travel from interstate/overseas

• Designated Biosecurity Areas Map - Western Australia

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Definitions Designated Biosecurity Areas are indicated on the attached map. Detailed maps are

available online at https://www.wa.gov.au/government/publications/biosecurity-act-designated-regions

Essential Activity in a designated Biosecurity Act area means any of the following: (a) providing any of the following for the benefit of one or more persons in the area:

(i) health care; (ii) education; (iii) services relating to prevention of, or recovery from, domestic violence; (iv) services relating to child protection; (v) policing services; (vi) emergency services; (vii) essential services of a kind typically provided by local government, such as rubbish collection; (viii) services, benefits, programs or facilities that the Chief Executive Centrelink has the function of providing;

(b) providing correctional services in relation to one or more persons in the area; (c) providing funerary services in the area; (d) conducting, or taking part in, a sitting of a court or tribunal in the area; (e) operating, maintaining, repairing or replacing:

(i) equipment for providing electricity, gas, water, medical services, telecommunications or broadcasting services; or

(ii) other essential infrastructure in the area; (f) delivering food, fuel, mail or medical supplies in the area; (g) obtaining medical care or medical supplies in the area; (h) continuing the construction in the area of housing or transport infrastructure that was in progress immediately

before the commencement of this instrument; (i) carrying out mining operations (including operations for the extraction of oil or gas), or operations ancillary to

mining operations, in the area in a manner that is agreed with a human biosecurity officer so as to minimise the extent to which other persons in the area are exposed to the persons carrying out those operations;

(j) transporting freight to or from a place in the area; (j) carrying out commercial primary production (including commercial processing of primary products to make food

from them, veterinary services for animals kept, used or bred for commercial primary production, aquaculture and agribusiness) in the area in a manner that is agreed with a human biosecurity officer so as to minimise the extent to which other persons in the area are exposed to the persons carrying out the production;

Isolated from the general public means: • You stayed at your home or other accommodation. • In a private house – you remained either inside or in your garden/courtyard. In an apartment or hotel, if you left

the private part of your accommodation to go to a garden/courtyard, you moved quickly through any common areas and did not come into contact or proximity with other people.

• Only people who usually live with you were in the home/accommodation. You did not see visitors. If in a hotel, you avoided contact with other guests or staff. Food and other necessities were brought to you by people who were not in isolation.

Symptoms include any of the following: (a) a fever of 38 degrees or above; or (b) a history of fever (including symptoms of a fever such as night sweats or chills); or (c) symptoms of acute respiratory infection (including, but without limitation, shortness of breath, a cough, sore

throat and/or fatigue).

Biosecurity officer means: (a) the Director of Human Biosecurity (b) the chief human biosecurity officer (c) a human biosecurity officer (d) a biosecurity officer (e) an official performing functions under an Australian law relating to public health or biosecurity.

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Travel for a ‘Permitted Purpose’ A number of travel restrictions have been put in place to limit the spread of human coronavirus. The definition below describes the Permitted Purposes for interstate and regional travel. Meeting these criteria alone does not mean you are allowed to enter a Designated Biosecurity Area. You must also meet the requirements set out on pages 1 and 2 of the entry form.

Travel within Western Australia Travel from Interstate

For a person entering a Designated Biosecurity Area from another part of Western Australia, travel for a Permitted Purpose means travel that is not prohibited by clause 4 of the Prohibition on Regional Travel Directions made on 31 March 2020 (available online at wa.gov.au/soedeclarations).

For indicative purposes only, this means travel that is: (a) within a region; (b) necessary for the person to return to their principal place

of residence; (c) necessary for the person to attend their place of

employment or fulfil the duties of their employment, office or occupation;

(d) necessary for the purpose of being a primary carer; (e) necessary to escape the threat of physical or psychological

harm or because of some other emergency (other than from COVID-l9);

(f) necessary to obtain a good or service which is not reasonably available in the region in which the person is present, and without which the person would be likely to suffer physical or psychological harm;

(g) necessary for the person to: (i) attend primary, secondary or tertiary education

(including technical and further education) as a student; or

(ii) enable the education of someone for whom the person has parental or other primary caring responsibility;

(h) necessary to fulfil the person’s obligations under a parenting plan, parenting order of a court or other parenting arrangement;

(i) necessary to obtain or provide veterinary or animal welfare services not reasonably available otherwise;

(j) necessary for compassionate reasons; (k) necessary for the person to deliver an essential service as

defined in clause 7 of the Prohibition on Regional Travel Directions available online at wa.gov.au/soedeclarations (note: some of these essential services are covered in the definition of Essential Activity above, and can therefore be done without a prior period of self-isolation if the activity is either urgent or covered by an approved management plan)

(l) undertaken while the person is in the custody of a police officer, prison officer, custodial officer or custodial services contractor; or

(m) undertaken by an employee of the Department of Education or staff member of a non-government school, who is authorised in writing by the Director General of the Department of Education to travel from one region to another region;

(n) undertaken by a member of the immediate family or household of a person referred to in paragraph (m);

(o) required by law; or (p) approved by an authorised officer and complies with any

applicable terms or conditions.

For a person entering a Designated Biosecurity Area from outside Western Australia, travel for a Permitted Purpose means travel that is not prohibited by clauses 4 and 5 of the Quarantine (Closing the Border) Directions made on 5 April 2020 (available online at wa.gov.au/soedeclarations).

For indicative purposes only, this means travel by: • certain senior Government, judicial and military

positions; • people carrying out functions under a law of the

Commonwealth; • certain health workers; • emergency service workers; • people requiring urgent and essential medical

treatment; • cross-border transport, freight and logistics

workers (provided they do not stay longer than is necessary to deliver that service);

• specialists required for industry or business continuity and maintenance of competitive operation where the service is time-critical;

• workers maintaining or repairing critical infrastructure;

• FIFO workers (and, in certain circumstances, their family members) provided they comply with strict quarantine provisions and self-isolate for 14 days at a specified location at the employer’s expense;

• workers (other than FIFO workers) employed or engaged in agriculture, food production or primary industry that requires the person to be physically present in Western Australia;

• people attending a funeral or visiting a relative who has had a serious medical episode or whose death is imminent;

• subject to obtaining special approval and complying with any relevant quarantine directions: o people required to travel to Western Australia

to care for a family member or dependent person;

o dependents who must travel to Western Australia to reside with their carer or relative;

o people obtaining essential goods or services necessary for the preservation of life;

o people complying with a court order; o students at an boarding school or residential

college returning home; • others approved in writing by the State Emergency

Coordinator (or other authorised officer) who comply with any applicable terms or conditions (which may include a quarantine direction).

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Economic & Geospatial Analysis SectionPolicy Analysis & Evaluation Branch

NIAA March 2020, Ref:2020/30

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Designated Biosecurity Areas - Western Australia




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Government of Western Australia - Entry into Designated Biosecurity Areas Form - WA.gov.au - 020220 of 9

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If you do not fall within one of the categories of authorised travel, you may apply for a Special Permission.

To apply, complete the declaration below and the primary entry form, and either: • email both forms to [email protected]; or

• provide both forms to an officer authorised under the Emergency Management Act 2005 (WA).

You may not enter the Designated Biosecurity Area unless and until you are advised that the Special Permission has been granted. This may take up to three (3) working days.

Declaration

I,_____________________________ (print your name), hereby apply under section 5(4) of the Biosecurity (Human Biosecurity Emergency) (Human Coronavirus with Pandemic Potential) (Emergency Requirements for Remote Communities) Determination 2020, made under the Biosecurity Act 2015 (Cth), for Special Permission to enter the Kimberley / East Pilbara / Ngaanyatjarraku Designated Biosecurity Area (circle the relevant area).

I confirm that I meet all of the following criteria:

• immediately before entering the Designated Biosecurity Area, I do not have any of the signs or symptoms of human coronavirus with pandemic potential (see definition of Symptoms in Definitions section);

• in the 14 days immediately before the entry, I have not been exposed, without adequate personal protective precautions, to human coronavirus with pandemic potential;


• in the 14 days immediately before the entry, I have not been outside Australian territory (as defined in s 12 of the Biosecurity Act 2015);

• I am not entering the area wholly or partly for the purpose of engaging in an activity in the area that is prohibited by or under an Australian law;

• my entry to the area is not otherwise prohibited by or under an Australian law, including any direction made under the Emergency Management Act 2005 (WA).

These are the reasons why I believe I should be allowed to enter the Designated Biosecurity Area:

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________ I declare that:

• I have read and understood this form;

• I understand that the categories of Permitted Purposes must be read in the context of the relevant directions restricting travel to Western Australia and within Western Australia;


• The information I have provided is not false or misleading in any respect. I acknowledge that the provision of false or misleading information may constitute an offence punishable by a fine or imprisonment.

This information is required for the purposes of the Biosecurity Act 2015 (Cth). The information is collected and will be used for the purposes of assisting the Chief Human Biosecurity Officer and/or human biosecurity officers to exercise their powers and perform their functions under the Biosecurity Act 2015 (Cth) in relation to the novel coronavirus COVID-19. The information may also be used for the purpose of assisting the State Emergency Coordinator and the Chief Health Officer in the exercise of their powers, and performance of their functions, under the Emergency Management Act 2005 (WA) and the Public Health Act 2016 (WA) respectively in relation to the novel coronavirus COVID-19.

Year Day Month Signature

Attachment A Special Permission

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