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FDC and RCP COVID-19 temporary closure form

Fill out this form when you need to temporarily close your service due to COVID-19.

Use this form when you need to close your service and can't provide care to children if:

  • you have tested positive to COVID-19
  • you have been in close contact with a confirmed case of COVID-19
  • you have been directed to quarantine by SA Health.

This form is part of the COVID -19 Confirmed Care Temporary Closure Protocol (PDF 201KB) and should be completed in conjunction with this protocol.

Educator details
For example – jane.doe@gmail.com
For example – 0412 345 678
For example – (08) 8123 4567
Closure details

Acknowledge statement

Educator acknowledgement

Please select the yes checkbox below to acknowledge you understand and agree to the following:

  • I have contacted all my families as per the COVID-19 Confirmed Case Temporary Closure Protocol.
  • During my service closure I will remain registered as a FDC educator or RCP care provider.
  • I will not receive home visits during my service closure but will receive and can access support from staff as needed.
  • I will continue to receive emails, newsletters, and general information during my service closure.
  • I understand and will follow the steps outlined in the COVID-19 Confirmed Case Temporary Closure Protocol including advising when able to re-open.
  • In accordance with current SA Health advice and emergency management directions, I am required to quarantine and close my service.  

By submitting this form, you declare all information to be true and correct on 5 October 2022.


Family Day Care Business and Customer Support Centre

Phone (metro): 8343 6533
Phone (country): 1300 551 890
Email: educationfdcbusiness@sa.gov.au