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FDC and RCP COVID-19 – ‘Test to Stay’ form

Use this form when a child in your care tests positive to COVID-19 and you want to remain open and will be participating in the ‘test to stay’ protocol.

A rapid antigen test (RAT) is to be undertaken on Monday, Wednesday and Friday before care commences.

A negative result each test day will allow you to continue to operate.

Children (apart from those who test positive) are to be encouraged to continue to attend the service if they don’t have any symptoms.

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

COVID-19 – Test to stay form

Educator details
For example – jane.doe@gmail.com
For example – 0412 345 678
For example – (08) 8123 4567
Child details that tested positive
Child 1
For example – 0412 345 678
Child 2
For example – 0412 345 678
Child 3
For example – 0412 345 678
Child 4
For example – 0412 345 678
Test to stay details
Educator acknowledgement

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

  • I have contacted all my families and advised that there has been a child in care that has tested positive.
  • I have informed all my families that I will be following the ‘test to stay’ protocol (RAT each Monday, Wednesday and Friday before care commences).
  • I will undertake a rapid antigen test each Monday, Wednesday and Friday before commencing care.
  • I understand that I can continue to stay open and provide care as long as I have a negative test day result and I do not have any symptoms of COVID-19.
  • I understand that if I test positive on any of the rapid antigen tests on the test days or I am required by SA Health to isolate and quarantine that I must:
    • lodge the positive test result and follow the instructions from SA Health
    • close my care service and advise families
    • complete the COVID-19 temporary closure form to advise the scheme office

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