Australian Capital Territory (ACT) Health Exemption Application

Who Should Submit this form

ACT residents who have travelled to an affected area and want to apply for an exemption from quarantine due to extenuating circurmstances; or
Non-ACT residents seeking to enter the ACT from an affected area.

Please Note: If you are a non-ACT resident and have been in an affected area, you may not enter the ACT without an exemption. Exemptions for non-ACT residents to enter the ACT from an affected area will only be considered in highly exceptional circumstances.

Information on current COVID-19 affected areas

ACT Public Health Directions require people who have visited the following affected locations to quarantine until 14 days after leaving the affected areas:

New South Wales

The following Local Government Areas (LGAs)

Blacktown City local government area
Burwood local government area
Canada Bay City local government area
Canterbury-Bankstown local government area
Cumberland local government area
Fairfield City local government area
Inner West local government area
Liverpool City local government area
Northern Beaches local government area
Parramatta City local government area
Strathfield Municipality local government area

A venue, location or public transport route at the same time as a confirmed case, as identified by NSW Health. These venues are both within and outside the LGAs listed above. Please refer to the NSW Health website for up to date information about affected venues, locations, and transport routes. It is your responsibility to stay up to date with evolving areas of concern.

Who is exempt from quarantine (do not fill out the form)

I am travelling from an affected area but will transit directly through the ACT, either through Canberra airport without leaving the airport, or by road or rail making no stops while in the ACT.
I have travelled through an affected area after the above dates, but my travel was restricted to transit purposes, including transit through Sydney airport where I either did not leave the airport or left the airport in order to then travel directly to the ACT by road or rail with no further stops in an affected area, or any other direct transit through the affected area by road or rail without stops.
I am travelling from the ACT to Sydney to collect someone from Sydney airport and am making no other stops in an affected area.
I am travelling by road from NSW to drop off a person in the ACT, making no other stops in the ACT and will have no contact with the public.
I am arriving in the ACT by air from an affected area and am immediately travelling into NSW by road.
I am a freight or transport driver travelling either into the ACT from an affected area for freight or transport service purposes, or am an ACT based freight or transport driver travelling into an affected area for freight or transport service purposes (excluding removalists – please fill out this form).
I am travelling to the ACT directly after finishing an unbroken 14-day quarantine period in mandatory hotel quarantine after arriving to an affected area from overseas.
I am from an affected area but have not been there in the past 14 days.
I have not spent time in an affected area except for reasons listed above.

Every individual must fill out a separate form.

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DO NOT SUBMIT THIS FORM IF YOU ARE EXEMPT FROM QUARANTINE.

Only submit this form if you have an extenuating circumstance and want to apply for an exemption from quarantine.

Domestic

International

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Domestic

International

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Interstate travellers and residents

Parliamentarians and staff (including partner/ dependents)

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Interstate travellers and residents

Parliamentarians and staff (including partner/ dependents)

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NSW

Victoria

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NSW

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NON-ACT resident from NSW requiring exemption to cross border

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NON-ACT resident from QLD requiring exemption to cross border

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Returning Diplomats (including partner/ dependents)

Returning Government Officials (including partner/ dependents)

Returning overseas traveller/ resident

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The national requirements for persons arriving to Australia from overseas are that they must enter into hotel quarantine at the port of entry.

If you are a returning traveller with exceptional circumstances seeking to quarantine in the ACT instead of your port of entry, or to quarantine at your home instead of an ACT hotel, you must fill out the form below.

Diplomat/Parliamentarian/Government Official

Spouse/Partner

Child/dependent

Staffer of official/parliamentarian/diplomat

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What is the name of the diplomat/parliamentarian/government official this person is attached to?

If the person is a family member of a staffer of an official/parliamentarian please include the name of the staffer and in brackets the official they work for.

E.g. If Mary was the chief of Staff for Joe Bloggs (parliamentarian) and you were completing Mary's husband Pete's record you would write: Mary (Joe Bloggs MP).

D-M-Y

I am allowed to travel under current public health restrictions

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Yes

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What affected LGA have you spent the most time in?

Northern Beaches local government area, New South Wales

Blacktown City local government area, New South Wales

Burwood local government area, New South Wales

Canada Bay City local government area, New South Wales

Canterbury-Bankstown local government area, New South Wales

Cumberland local government area, New South Wales

Fairfield City local government area, New South Wales

Inner West local government area, New South Wales

Liverpool City local government area, New South Wales

Parramatta City local government area, New South Wales

Strathfield Municipality local government area, New South Wales

None of the above

You are not required to apply for an exemption to enter the ACT. Only people who have been in the affected areas listed above need to apply for an exemption.

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Was your time in the area of concern restricted only to transit purposes, either:

Transit directly to Melbourne airport for the purpose of travelling to another state/territory by air; or
Transit* directly through the area of concern or restriction.

*Transit may include stops kept to a safe minimum at isolated rest areas, with minimal interactions and appropriate precautions taken. Advice on staying safe can be found here.

* must provide value

Yes

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Declaration - Please acknowledge that you understand the following:

I declare that:
• I have not been, and will not be, in an identified area of concern or restriction in Victoria (other than for transit purposes*),

• I have not had, and will not have, any household contact with a person who travels into an identified area of concern or an area of restriction in Victoria, within 14 days prior to my travel to the ACT.

• I understand that making a false or misleading declaration, or providing false or misleading information as part of my exemption application, is an offence which is subject to significant penalties of up to $16,000, imprisonment for 1 year (or both).

• If my situation changes and I enter an identified area of concern I will notify ACT Health as soon as possible.

* must provide value

I understand and acknowledge the declaration

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Please note that you MUST provide the relevant supporting documentation as per Section Four otherwise your application can not be assessed.

Note: If you are indefinitely relocating to the ACT for work then please select the category ‘moving to the ACT'.

If you are moving to the ACT, you must provide the following documentation:

Proof of permanent employment in the ACT (letter from employer); or proof of long term accommodation arrangements greater than six months; AND
Two forms of ID (photo ID and proof of current address).

Applicants applying for essential worker status in construction, engineering and manufacturing MUST upload supporting documentation that provides details of the following:

Name of project, description of project and location
Details of Head Contractor and contact details
Nature of the services they are performing
Confirmation as to whether it is an ACT Government or private project
A reference from the head contractor setting out the critical need for the services to be provided

Supporting documents can be attached in section three of this form.

Note: If either of these situations apply to you, you do not need to complete this form:

Entering via air to the Canberra airport and transiting to another jurisdiction by air, and do not leave the Canberra airport OR
Entering the ACT by road with no stops, travelling directly through the ACT.

You do not need to complete this form, but you must ensure that you have a permit for the jurisdiction to which you are travelling.

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D-M-Y

Yes

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If you plan to stay in paid accommodation during your time in the Australian Capital Territory (ACT), please do not book until after your exemption has been approved, as if you are required to quarantine, you will need to stay in an approved hotel. The Office of the Chief Health Officer will contact you with a list of approved hotels.

For the Australian Capital Territory (ACT) paid accommodation and address fields, please enter "TBC" unless you have already booked your accommodation.

Please note that if you are approved to enter the ACT and required to quarantine, you will need to ensure the hotel is aware you will be in quarantine and has confirmed your arrival time - particularly if arriving early. You should also be aware that you will need to book 15 nights of accommodation in order to meet the ACT's mandatory quarantine requirements.

Please note if you are quarantining at a residential address, you must be appropriately separated from any other residents at the address. Appropriate separation means that you have access to a separate bedroom and bathroom. You must also ensure that all other people residing at the address are made aware of your requirement to quarantine.

Please note if you are quarantining at a residential address, all other residents of the household will need to be in quarantine if you are granted entry to the ACT. Please list the names of any other person(s) who will be residing at this household during your quarantine.

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You grant ACT Health permission to contact the paid accommodation you intend to stay at to assess the appropriateness of the accommodation for quarantine purposes.

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Yes

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I declare that I have read the above definition of suitable quarantine and confirm that I understand the requirements and will have access to a separate bedroom and bathroom at my quarantine address

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Yes

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ACT

NSW

VIC

QLD

TAS

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D-M-Y

IMPORTANT NOTE: If your exemption is granted, this is the date you will be required to enter the ACT. The exemption will not be valid for any other date.

D-M-Y

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H:M

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For all requests please provide the following supporting documentation:

Identification - must provide Drivers Licence or other form of photo ID.

Moving to the ACT:

You will need to provide evidence that:

You have secured employment for at least 6 months in the ACT that requires you to relocate (this should be in a letter from your employer) OR
You have a lease in the ACT of at least 6 months, and your current living arrangements are coming to an end.

Essential workers:

Must provide a supporting letter from the head of the organisation AT the site where you will be working in the ACT which details the tasks you are required to undertake, the critical need for the services to be provided at this time, and why these services can only be provided by you specifically and cannot be sourced from within the ACT or any jurisdiction outside of the COVID-19 affected area.

If you are a Health Care Worker working in an ACT Hospital (Public or Private sector), you must complete a staff exemption form signed by the relevant executive of the area and attach it to this application.

Exemptions will only be considered when it can be established that:

• The staff member’s role cannot be fulfilled by another individual, either local or interstate; or

• The staff member is deemed an essential worker (defined as: there would be a greater risk posed to patients and staff if the staff member was excluded from work).

Compassionate grounds:

If you are attending a funeral, you will need to supply a death certificate or letter from the funeral service provider granting permission for your attendance.

If you are intending to enter to visit a sick or palliative family member, or require care or support from a family member in the ACT, you will need to supply supporting documentation from your or their treating medical professional outlining their or your requirement for travel.

Needing to receive or attend a service:

You will need to provide supporting documentation from the service that verifies that this service is only available in the ACT, the service is comfortable with you attending, and an explanation as to why the entry is time critical. If this is a health service then please provide a letter from the health facility and your treating medical professional.

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Entering for child access:

You will need to provide proof of legal guardianship, and court documentation where possible. Note that exemptions from quarantine are not possible and child access will need to take quarantine requirements into consideration.

All applicants must include: Passport and flight itinerary.

Grounds for exemption	Additional documentation required
Medical – requires urgent medical treatment in the ACT	Letter from traveller’s treating medical professional
Medical – hotel quarantine not appropriate for medical or mental health reasons	Letter from traveller’s treating medical/mental health professional
Compassionate – visiting palliative or very ill immediate family member	Letter from family member’s treating medical professional which includes details of the patient’s condition. If the patient is currently in hospital, please include their date of birth and ward details.
Compassionate – attending funeral of immediate family member	Death certificate or letter from funeral director
Compassionate – needing to provide urgent care or support to immediate family member	Letter from family member’s treating medical professional
Essential work – Government employee needing to work from home during quarantine	Letter from employer detailing need for work at home during quarantine period
Unaccompanied minor	Photo identification of parent/guardian
Other exceptional circumstances	Any relevant documentation that validates these grounds

Required to attend court/legal proceeding:

You will need to provide evidence from the court that you are required to attend on (x date).

Residents of another state or territory seeking to return home:

You will need to show proof of address in your home state or territory. If returning to a jurisdiction other than NSW, you will also need to provide evidence of approval for your entry to that Jurisdiction. You will need to travel in a private vehicle to return home.

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I understand that if I cannot supply a suitable premises for mandatory quarantine, I am responsible for the costs associated for the Government approved accommodation.

I undertake to present for a COVID-19 test if I develop symptoms consistent with COVID-19 within 14 days of entering the ACT.

I acknowledge that the information collected by ACT Health may be shared with other government agencies (including ACT Policing and Government agencies outside the ACT Government) for the purposes of identity verification and the monitoring and enforcement of compliance with State and Territory public health laws.

I declare that the information I have provided in this application is true and correct to the best of my knowledge. I acknowledge that if this application is found to have knowingly provided false, misleading or incorrect information ACT Health may void an exemption granted on the basis of this application, and I may be charged with an offence(s) under the ACT Criminal Code 2002 which carries significant penalties.

I understand that I am required to quarantine for 14 days (since I last visited an area of concern) upon entry into the Australian Capital Territory (ACT) unless exempted from this requirement.

Please check all your information and ensure you have uploaded the supporting documentation. Once you click the “SUBMIT” button you will not be able to go back and change your details.

If you do feel you have an issue, please feel free to contact the COVID exemptions team at COVID.Exemptions@act.gov.au

IMPORTANT: YOU MUST CLICK THE "SUBMIT" BUTTON BELOW TO LODGE YOUR APPLICATION.

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