Attendance & Health Declaration

Training Date & Time

Distributor Name*

Name:*

First NameLast Name

Position/Title:*

Contact Number:

Area CodePhone Number

E-mail:

Facilitator Name:*

First NameLast Name

Training Title*

COVID-19 Daily Health Declaration Form

To continue our fight against COVID-19 and to ensure the health and safety of everyone in the worksite, it is expected from you to truthfully answer this health declaration form before attending the training that Nestlé Phils. Inc. will conduct. You have to declare your health condition, history of travel, and exposure.

When you submit this form, the owner will be able to see your name, contact no. and email address.

*Required to answer

1.Privacy Notice on COVID-19 Daily Health Declaration Form

Nestlé Philippines, Inc. is collecting your personal information pursuant to applicable public health laws to reduce the risk of transmission of the COVID-19 virus and to facilitate contact tracing. Your information will be shared only to authorized personnel of Nestlé Philippines and government agencies mandated by law to have access to the same. We will retain your data only for as long as required to legally keep the records, after which the records will be securely destroyed. https://bit.ly/3f7NQjo

By answering this form, I confirm that I have read the Privacy Notice on COVID-19 Daily Health Declaration Form.*

Agree

Are you experiencing any of the following?*

Have you worked together or stayed in the same close environment of a COVID-19 Confirmed, Suspect, or Probable Case in the past 14 days?*

YesNo

Have you had any contact with anyone with fever, cough, colds, or sore throat in the past 14 days?*

YesNo

Have you traveled to any area which was on total lockdown in the past 14 days?*

YesNo

What is your body temperature reading (in Celsius) today?*

I declare that all my answers are true and correct. It is my responsibility to comply with all of the safety and health protocols in preventing the spread of COVID-19 virus.*

Agree

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