Temporary Visitor Health Declaration Form
Full Name
Company/Organization
Date of Visit
Contact Number
Have you experienced any of the following symptoms in the past 14 days? (Fever, cough, sore throat, shortness of breath, loss of taste/smell)
No
Yes
If yes, please specify
Have you been in contact with a confirmed COVID-19 case in the last 14 days?
No
Yes
If yes, please provide details
Have you traveled internationally in the past 14 days?
No
Yes
If yes, please list countries visited
Declaration
Signature
Date