COVID-19 Symptom Declaration Form
Full Name
Date of Birth
Contact Number
Address
Department / Ward
Are you experiencing any of the following symptoms?
Fever
Cough
Sore Throat
Shortness of Breath
Loss of Taste/Smell
Headache
None
Have you had contact with a confirmed COVID-19 case in the last 14 days?
Yes
No
Have you traveled internationally in the last 14 days?
Yes
No
I declare that the information provided above is accurate and complete.