Contractor Pre-Entry COVID-19 Health Declaration
Full Name
Company
Date
Contact Number
Email Address
1. Do you have any of the following symptoms?
• Fever
• Cough
• Shortness of breath
• Sore throat
• Loss of taste or smell
• Other flu-like symptoms
Yes
No
2. Have you been in close contact with a confirmed COVID-19 case in the past 14 days?
Yes
No
3. Are you currently under mandatory quarantine or isolation as instructed by authorities?
Yes
No
4. Have you travelled internationally in the last 14 days?
Yes
No
Signature