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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 18 May 2022.


Family Day Care Business and Customer Support Centre

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